Aortic insufficiency is a heart valve disease in which the aortic valve does not close tightly. This leads to the backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (a chamber of the heart).

Aortic regurgitation causes

Aortic insufficiency can result from any condition that keeps the aortic valve from closing all the way. A small amount of blood comes back each time the heart beats.

The condition causes widening (dilation) of the left lower chamber of the heart. Larger amounts of blood leave the heart with each squeeze or contraction. This leads to a strong and forceful pulse (bounding pulse). Over time, the heart becomes less able to pump blood to the body.

In the past, rheumatic fever was the main cause of aortic insufficiency. Now that antibiotics are used to treat rheumatic fever, other causes are more commonly seen.

Causes of aortic insufficiency may include:

• Ankylosing spondylitis
• Aortic dissection
• Congenital (present at birth) valve problems, such as bicuspid valve
• Endocarditis 
• High blood pressure
• Marfan syndrome 
• Reiter syndrome (also known as reactive arthritis)
• Syphilis
• Systemic lupus erythematosus

Aortic insufficiency is most common in men between the ages of 30 and 60.

Aortic regurgitation symptoms

Aortic insufficiency often has no symptoms for many years. Symptoms may occur slowly or suddenly.

• Bounding pulse
• Chest pain, angina type (rare)
• Under the chest bone; pain may move to other areas of the body, most often the left side of the chest
• Crushing, squeezing, pressure, tightness
• Pain increases with exercise and goes away with rest
• Fainting
• Fatigue
• Palpitations (sensation of the heart beating)
• Shortness of breath with activity or when lying down
• Swelling of the feet, legs or abdomen
• Uneven, rapid, racing, pounding or fluttering pulse
• Weakness, more often with activity

Signs may include:

• A heart murmur when the health care provider listens to the chest with a stethoscope
• A very forceful beating of the heart
• The head may bob in time with the heartbeat
• Hard pulses in the arms and legs
• Low diastolic blood pressure
• Signs of fluid in the lungs

Diagnosing aortic valve insufficiency

Aortic insufficiency may be seen on:

• Aortic angiography
• Echocardiogram – ultrasound examination of the heart
• Left heart catheterization
• MRI of the heart 
• Transesophageal echocardiogram (TEE)

A chest X-ray may show swelling of the left lower heart chamber. Lab tests cannot diagnose aortic insufficiency, but they may be used to rule out other disorders or causes.

Aortic regurgitation treatment

If there are no symptoms or if symptoms are mild, you may only need to get an echocardiogram from time to time and be monitored by a health care provider.

If your blood pressure is high, then treatment with certain blood pressure medications may help slow the worsening of aortic regurgitation.

ACE inhibitor drugs and diuretics (water pills) may be prescribed for more moderate or severe symptoms.

In the past, most patients with heart valve problems were given antibiotics before dental work or an invasive procedure, such as colonoscopy. The antibiotics were given to prevent an infection of the damaged heart. However, antibiotics are now used much less often before dental work and other procedures.

You may need to limit activity that requires more work from your heart. Talk to your health care provider.

Surgery to repair or replace the aortic valve corrects aortic insufficiency. The decision to have aortic valve replacement depends on your symptoms and the condition and function of your heart.

You may also need surgery to repair the aorta if it is widened.