Aortic Insufficiency

Aortic insufficiency is a condition where the aortic valve does not close all the way. The aortic valve is a gatelike structure that is located between the lower left chamber of the heart (left ventricle) and the blood vessel that leads away from the heart (aorta). The aortic valve opens when the left ventricle squeezes to pump blood into the aorta, and it closes when the left ventricle relaxes.

ExitCare ImageIn aortic insufficiency, blood in the aorta leaks through the aortic valve after it has closed. As a result, the heart works harder to pump the same amount of blood through the valve as it would if the valve closed tightly. When left untreated, aortic insufficiency causes enlargement and weakening of the left ventricle. When this happens, the heart fails to pump blood as well as it should, and heart failure, abnormal heart rhythms (arrhythmias), and other dangerous conditions may develop.

CAUSES

Anything that weakens the aortic valve can cause aortic insufficiency. Examples include:

  • Severe high blood pressure (hypertension).

  • Inflammation of the lining of the heart (endocarditis).

  • A ballooning of a weak spot in the aorta wall (aortic aneurysm).

  • A tear or separation of the inner walls of the aorta (aortic dissection).

  • Trauma that damages the aortic valve.

  • Certain drugs.

  • Complications during or after a heart surgery (rare).

  • Disease of the protein in the body called collagen (collagen vascular disease).

  • A birth defect.

  • Rheumatic fever.

SYMPTOMS

Unless a major injury or endocarditis caused aortic insufficiency, symptoms usually develop very slowly over time. Symptoms may include:

  • Weakness and tiredness (fatigue).

  • Shortness of breath.  

  • Difficulty breathing while lying flat (orthopnea). You may be sleeping on two or more pillows to breathe better.

  • Chest discomfort (angina).  

  • Head bobbing.

  • A fluttering feeling in your chest (palpitations).

  • An irregular or faster-than-normal heartbeat.

DIAGNOSIS

Aortic insufficiency is usually diagnosed with a physical exam and with a type of imaging test called echocardiography. Echocardiography uses sound waves to produce images of the heart. Other tests may also be done to confirm the diagnosis. They may include:

  • Chest X-ray.

  • MRI.

  • Electrocardiography. This is a test that records the electrical impulses of the heart.

  • Angiography. This is a test that produces images of arteries in your body. You may need aortic angiography or CT angiography. In aortic angiography, a dye flows to your heart through a soft, flexible tube (catheter) while X-rays are taken. CT angiography uses a CT scanner and MRI in addition to the catheter, dye, and X-rays.

TREATMENT

Treatment depends on how severe the aortic insufficiency is, the problems it is causing, and your symptoms.

  • Observation. If the aortic insufficiency is mild, no treatment may be needed. However, you will need to have the condition checked regularly to make sure it is not getting worse or causing serious problems.

  • Surgery. If the aortic insufficiency becomes severe, you may need surgery to repair or replace the valve. Surgery is usually recommended if the left ventricle enlarges beyond a certain point. If aortic insufficiency occurs suddenly, surgery may be needed immediately.

  • Medications. Some medications may help the heart work more efficiently. 

HOME CARE INSTRUCTIONS

  • Keep all follow-up appointments. You may need to have tests done regularly to monitor your condition and how well your heart is pumping blood.

  • Notify your caregiver of your aortic insufficiency if you will be having ear, nose, or throat surgery; surgery to your lungs; or dental surgery if:

  • You have had endocarditis.

  • You have an artificial heart valve.

  • You have had surgery to repair a heart valve using a synthetic or biologic material. 

  • Take medications as directed by your caregiver.  

SEEK MEDICAL CARE IF:

  • Your chest symptoms seem to be getting worse.

  • Your breathing problems seem to be getting worse.

  • You feel dizzy or close to fainting.

  • You have swelling of the feet, ankles, legs, or abdomen.

  • You urinate more than usual during the night (nocturia).

  • You have an unexplained fever lasting 2 or more days.

  • You have new symptoms that cause concern.

SEEK IMMEDIATE MEDICAL CARE IF:

  • You have severe chest pain.

  • You have severe shortness of breath.

  • You feel rapid or irregular heartbeats.

  • You feel lightheaded.  

  • You have unexplained, sudden weight gain.

MAKE SURE YOU:

  • Understand these instructions.

  • Will watch your condition.

  • Will get help right away if you are not doing well or get worse.