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View this article online at: patient.info/health/aortic-regurgitation-leaflet
Aortic Regurgitation
Aortic regurgitation is a condition in which blood leaks back through the aortic valve. This is because
the valve does not close properly. With each heartbeat, more blood than usual enters the left
ventricle and so it needs to work harder. Mild regurgitation may not cause symptoms. More severe
regurgitation can cause symptoms and may lead to heart failure. Medication can help to ease
symptoms. Surgery to replace the valve may be needed.
Understanding the heart
The heart has four chambers - two atria and two ventricles. The walls of these chambers are mainly made of
special heart muscle. During each heartbeat both of the atria squeeze (contract) first to pump blood into the
ventricles. Then both ventricles contract to pump blood out of the heart into the arteries. There are one-way
valves between the atria and ventricles, and between the ventricles and the large arteries coming from the heart.
The valves make sure that when the atria or ventricles contract, the blood flows in the correct direction.
What is the aortic valve and what is aortic regurgitation?
The aortic valve lies between the left ventricle and the aorta. When the left ventricle relaxes, the aortic valve
closes and the mitral valve opens. This allows more blood into the ventricle, ready for the next heartbeat.
Aortic regurgitation is sometimes called aortic incompetence or a leaky aortic valve. In aortic regurgitation the
valve does not close properly. Therefore, blood leaks back (regurgitates) into the left ventricle from the aorta.
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In some cases, aortic regurgitation occurs at the same time as aortic stenosis. See separate leaflet called Aortic
Stenosis for more details.
What are the causes of aortic regurgitation?
The main causes include the following:
Rheumatic fever
Rheumatic fever is a condition that sometimes occurs during an infection with a germ (bacterium) called the
streptococcus. Your body makes antibodies to the bacterium to clear the infection. However, in some people the
antibodies also attack various parts of the body, in particular the heart valves. Inflammation of a valve may
develop which can cause permanent damage and lead to thickening and scarring years later.
Abnormal widening of the base of the aorta
If the root of the aorta becomes abnormally wide, the cusps of the valve cannot meet and the valve becomes
leaky. The tissue at the base of the aorta can be affected by various conditions such as: Marfan's syndrome,
ankylosing spondylitis, rheumatoid arthritis, reactive arthritis, relapsing polychondritis, syphilis.
Other causes:
Congenital causes. (A congenital condition is a condition that is present from birth.) Various heart
problems which may be present at birth may include aortic regurgitation.
Infection of the valve (endocarditis). See separate leaflet called Infective Endocarditis for more details.
What are the symptoms of aortic regurgitation?
If the leak is small you are not likely to have any symptoms.
If the backflow of blood becomes worse the left ventricle has to work harder with each heartbeat to
pump the extra blood back into the aorta. The wall of the ventricle may then enlarge and may also
become thickened (hypertrophied). Symptoms can then include:
Dizziness.
Chest pain (angina) when you exert yourself. This occurs because of reduced blood flow to
the coronary arteries.
Forceful heartbeats which you may feel as the sensation of having a 'thumping heart'
(palpitations).
If the backflow of blood is severe the left ventricle may not function properly and you can develop
heart failure. This causes shortness of breath, tiredness and fluid retention in various tissues of the
body.
What are the possible complications of aortic regurgitation?
Heart failure may become severe and life-threatening. See separate leaflet called Heart Failure for
more details.
Infection of the valve (endocarditis) is an uncommon complication. (Abnormal valves are more
prone than normal valves to infection.) Unless promptly treated, endocarditis can cause serious
illness.
How is aortic regurgitation diagnosed?
A doctor may hear a heart murmur or other abnormal noises when listening with a stethoscope.
Murmurs and noises are due to blood passing through abnormal valves, or to abnormal movement of
valves. There are typical murmurs and noises which occur with aortic regurgitation. Sometimes this is
detected on a routine examination if you have no symptoms, and the regurgitation is mild.
A heart tracing (an electrocardiogram, or ECG) can show that the left ventricle is thickened or
enlarged.
An ultrasound scan of the heart (echocardiogram) can confirm the diagnosis.
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What are the treatments for aortic regurgitation?
If the backflow of blood is mild and you have no symptoms then you may not need any treatment. If you develop
symptoms or complications, various medicines may be advised to ease the symptoms. Surgery may be advised
if symptoms become worse.
Medication
Medication may be advised to help ease symptoms of heart failure if heart failure develops. For example:
'Water' tablets (diuretics) usually help if you are breathless. They make the kidneys produce more
urine. This gets rid of excess blood and fluid which may build up in the lungs or other parts of the body
with heart failure.
Angiotensin-converting enzyme (ACE) inhibitors are medicines which help to reduce the amount
of work the heart does and to ease symptoms of heart failure.
Surgery
Surgical options include repair of the aortic valve or replacement of the valve. Valve replacement surgery may be
with a mechanical or a tissue valve. Mechanical valves are made of materials which are not likely to react with
your body, such as titanium. Tissue valves are made from treated animal tissue, such as valves from a pig. If you
need surgery, a surgeon will advise on which is the best option for your situation.
Surgical treatment has greatly improved the outlook in most people with more severe regurgitation. The outlook is
good if the valve is treated before the heart becomes badly damaged.
Antibiotics to prevent endocarditis
Antibiotics used to be offered to all people with heart valve disease before dental treatment and some surgical
procedures to prevent the development of infection of the valve (endocarditis). However, the National Institute for
Health and Care Excellence (NICE) issued guidance in 2008 which advised that people at risk of endocarditis
only need to take antibiotics if they actually have an infection at the time that dental or surgical procedures are
undertaken.
Dental health
Good oral and dental hygiene are also thought to be important in helping to prevent infective endocarditis. In
particular, if you have any condition which increases your risk of developing infective endocarditis (see above),
you should not let any dental problems such as a dental abscess or gum disease go untreated. These dental
conditions increase the chance of germs (bacteria) getting into the bloodstream.
What is the outcome (prognosis)?
The outcome will depend on the underlying cause and the severity of aortic regurgitation. The outcome is
generally poor if there is no treatment but is good with available modern treatments.
Further help & information
British Heart Foundation
Greater London House, 180 Hampstead Road, London, NW1 7AW
Tel: (Heart Helpline) 0300 330 3311, (Admin) 020 7554 0000
Web: www.bhf.org.uk
Further reading & references
Management of Valvular Heart Disease; European Society of Cardiology (2012)
Nishimura RA, Otto CM, Bonow RO, et al; 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart
Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on
Practice Guidelines. Circulation. 2014 Jun 10;129(23):2440-92. doi: 10.1161/CIR.0000000000000029. Epub 2014 Mar 3.
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Prophylaxis against infective endocarditis: Antimicrobial prophylaxis against infective endocarditis in adults and children
undergoing interventional procedures; NICE Clinical Guideline (March 2008)
Tourmousoglou C, Lalos S, Dougenis D; Is aortic valve repair or replacement with a bioprosthetic valve the best option for
a patient with severe aortic regurgitation? Interact Cardiovasc Thorac Surg. 2014 Feb;18(2):211-8. doi: 10.1093/icvts/ivt453.
Epub 2013 Nov 7.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical
conditions. EMIS has used all reasonable care in compiling the information but makes no warranty as to its
accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions.
For details see our conditions.
Original Author:
Dr Tim Kenny
Current Version:
Dr Colin Tidy
Peer Reviewer:
Dr Adrian Bonsall
Document ID:
4710 (v43)
Last Checked:
24/11/2015
Next Review:
23/11/2018
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