Aortic Regurgitation

GENERAL INFORMATION:

What is aortic regurgitation? Aortic regurgitation (ree-ger-jih-TA-shun) or AR, is also known as aortic insufficiency (AI) (in-suh-FISH-in-c). AR is when the aortic valve in the heart does not close completely. Because the valve never closes completely, blood leaks backward from the aorta into the left ventricle (VEN-trik-ull).

Where is the aortic valve?

• The heart has 4 chambers (rooms). The two upper chambers are called atria (A-tree-uh) and the two lower chambers are called ventricles. When the heart "beats", the atria pump blood into the ventricles. The ventricles then pump blood out of the heart. The right ventricle pumps blood into the pulmonary artery then into the lungs to get oxygen. The left ventricle pumps the blood with oxygen into the aorta and out to the body.
  
  
• There are valves (doors) between the chambers that open and close to direct blood flow through the heart. The aortic valve is between the left ventricle and the aorta. The aortic valve is made up of 3 "cusps". The cusps come from the sides and top of the valve and meet in the middle. As the heart beats, the aortic valve opens to let blood flow from the left ventricle into the aorta. When the heart rests between beats, the aortic valve should close and keep blood from flowing backward into the left ventricle.

• When blood leaks backward from the aorta into the left ventricle your body may not get enough blood. Your heart tries to make up for the smaller amount of blood pumping into the body by pumping harder. If your AR is not very bad, your heart may be able to pump harder for your whole life. But, AR might make your heart weaker over time.
  
  
• Your aortic regurgitation may slowly get worse. If your heart gets weaker, you may start having symptoms. You may notice that you can feel your heartbeat--especially in your neck or head. You may have trouble breathing, or have chest pain when you are exercising or climbing stairs. You may have trouble breathing when you lie down flat. Your feet and ankles may swell.

• Rheumatic (rew-MAH-tik) fever.
  
  
• Infective (in-FEK-tiv) endocarditis (end-o-kar-DI-tis).
  
  
• Heart valve problems at birth. The aortic valve may have one or two cusps instead of three.
  
  
• The cusps may be deformed.
  
  
• Problems in the aorta that force blood backwards into the left ventricle.
  
  
• Deterioration (breaking down) of the valve with age.
  
  
• Injury to the heart, from an accident or a heart attack.
  
  
• Past use of certain diet drugs.
  
  
• Other diseases.

• Hearing your heart beating, especially in your head and neck.
  
  
• Shortness of breath during exercise or activities like climbing stairs.
  
  
• Shortness of breath when you lie down or at night.
  
  
• Waking up at night coughing or gasping for air.
  
  
• Swelling feet and ankles.
  
  
• Feeling faint or actually fainting during exercise or activities.
  
  
• Heart murmur (extra sound) when caregivers listen to your heartbeat.

• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Echocardiogram:
  
  
  
  
  • This test is also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen.
    
    
  • This test is done while lying down on your back. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor will be rubbed across your chest to see your heart from different angles. You may hear a barking or whooshing noise, which is the sound of your blood flow. Caregivers may ask you to pedal a bike during the test (exercise echo) or you may get medicine before the test to increase blood flow to your heart muscle (stress echo). This test can tell how well your heart is pumping. An echo can also find problems, such as fluid around the heart or problems with your heart valves.
  
  
• Cardiac blood pool imaging: This test shows how well your heart is pumping. It can also be called a "gated blood pool scan" or a MUGA scan. You are given a small, safe amount of radioactive dye in an IV. Caregivers then take pictures of your heart.
  
  
• MRI: This test is also called magnetic resonance (REH-zuh-nuns) imaging. MRI allows your caregivers to see inside your body. During the MRI pictures are taken of your aortic valve. Caregivers use these pictures to look for aortic regurgitation.

• Antibiotic (an-ti-bi-AH-tik) medicine.
  
  
• Diuretic medicine (water pills).
  
  
• Heart medicine.
  
  
• Blood thinning medicine.
  
  
• Low sodium diet.
  
  
• Surgery to repair or replace the aortic valve.