Valvular heart disease / Aortic regurgitation

Overview – Aortic regurgitation is a valvular heart disease that occurs when there is inadequate closure of the aortic valve leaflets.

The heart pumps blood from the left ventricle (Left lower chamber) into the aorta through the aortic valve. Aorta is the main artery that carries blood from the heart to the body. Because the aortic valve doesn’t close properly, the blood leaks backward from the aorta into the left ventricle. The regurgitant blood can lead to enlargement and hypertrophy of the left ventricle.

The most common cause of aortic regurgitation is rheumatic heart disease in developing countries. In developed countries, the most common cause is aortic root dilation, congenital bicuspid aortic valve, and calcific valve disease.

 

Symptoms

  • Some people with aortic regurgitation may remain asymptomatic.
  • Symptoms include exertional shortness of breath, chest pain, swollen ankles, and feet, shortness of breath while sleeping, palpitations, fatigue, and weakness.

 

Complications

  • Heart failure – Hypertrophy and left ventricular enlargement because of regurgitant blood can lead to heart failure.
  • Sudden cardiac death.
  • Endocarditis (infection of the heart tissue).

 

Diagnosis

  • Echocardiography is done to confirm the diagnosis in a patient with signs and symptoms of aortic regurgitation.
  • Other tests that may be done are electrocardiogram to detect the enlarged chambers of your heart, heart disease, and abnormal heart rhythms; chest x-ray to determine the enlargement of the heart; exercise or stress test to determine the severity of the condition; cardiac catheterization may be used sometimes to diagnose or determine the severity of the condition; cardiac MRI to determine the severity of aortic regurgitation and evaluate the size of your aorta.

 

Lifestyle management

  • Follow a healthy diet and exercise program as recommended by your doctor. Your doctor will recommend a heart-healthy diet that includes lean proteins, fruits, vegetables, and whole grains. Your diet should be low in saturated fat, trans fat, salt. Check with your doctor before starting to exercise, especially if you’re considering competitive sports.
  • Keep all the appointments with your doctor. Your doctor will do regular echocardiograms to make sure aortic valve regurgitation doesn’t become severe.
  • Aortic valve regurgitation due to rheumatic fever can be prevented by taking steps to prevent rheumatic fever from happening. Rheumatic fever is a complication of untreated strep throat. Rheumatic fever causes inflammation, especially of the heart, blood vessels, and joints. Make sure you see your doctor when you have a sore throat. Strep throat can usually be easily treated with antibiotics.
  • Manage your weight well. Blood pressure and cholesterol levels should be under control when you have an aortic valve regurgitation. Talk to your doctor about ways to keep your blood pressure, cholesterol within the limits recommended by your doctor.
  • If you smoke, quit smoking.
  • Manage stress well with relaxation activities, meditation, spending time with friends and family.
  • If you are planning a pregnancy, talk to your doctor before pregnancy about your risks.

 

Medical management

  • Aortic valve surgery is the mainstay of treatment for patients with symptomatic aortic regurgitation, or for those who have aortic regurgitation and left ventricular dysfunction. Aortic surgery options are aortic valve repair or aortic valve replacement. In aortic valve replacement, the damaged valve is removed and replaced by a mechanical valve or a valve made from cow, pig or human heart tissue (biological tissue valve).
  • Other treatment options depend on the complications of aortic regurgitation. Heart failure is treated with diuretics and/or ACE inhibitors.

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