Aortic Insufficiency

Aortic insufficiency (AI) is a condition where the valve between the heart and the aorta (the big vessel that pumps blood to the entire body) does not close well enough. This means the heart has to work harder to pump the same amount of blood than it would if the valve closed tightly. Every time the heart beats, some of the blood leaks back into the heart. This would be like bailing out a boat with a leaky bucket. Over time, this condition leads to high blood pressure and eventually causes the heart to fail.


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

  • Rheumatic fever.

  • Congenital (present at birth) valve abnormalities.

  • Aortic aneurysm (a ballooning of a weak spot in the vessel wall).

  • Syphilis.

  • Some collagen diseases and genetic problems.

AI also can be caused by infection or injury or can develop following the repair of aortic stenosis (a narrowing of the valve that does not let enough blood through).


  • Weakness and fatigue.

  • Shortness of breath.

  • Needing to sleep on 2 or more pillows at night to breathe better.

  • Chest discomfort.

  • Head bobbing.


The diagnosis of AI can usually be made with a physical exam and an echocardiogram. An echocardiogram is a test that uses ultrasound to examine the heart. Other tests may also be done to confirm the diagnosis.


  • If there are mild to no symptoms, only observation may be needed. With severe problems, hospitalization may be necessary.

  • Medications may be used to prevent an infection forming on the valves, to keep symptoms from getting worse or to delay surgery for 2 or 3 years. Some medications commonly used for AI help the heart work better.

  • Surgery to repair or replace the valve is usually reserved for last. Surgery results in better outcomes if not delayed too long.

  • Sudden onset of AI may require urgent surgery to replace the valve.


  • Echocardiograms (a sound wave picture of the heart and great vessels) are done periodically to monitor treatment.

  • Notify the health care provider or dentist about any history of heart valve disease before treatment for any condition. Any dental work, including cleaning, and any invasive procedure can introduce bacteria into the bloodstream. Bacteria can infect a weakened valve causing endocarditis.

  • Take any medications as prescribed.


  • Chest or breathing problems that get worse occur.

  • You notice irregular heartbeats.

  • You have unexplained fevers.


  • You have new or severe shortness of breath.

  • You experience lightheadedness.

  • New or severe chest pains occur.

  • There are rapid or irregular heartbeats related to the above symptoms.


  • Understand these instructions.

  • Will watch your condition.

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