Aortic regurgitation often symptom-free when mild

Dear Doctor: I am a 72-year-old man and have been diagnosed with aortic regurgitation. My cardiologist said since I’m not experiencing any of the usual symptoms connected with this, he thinks I should just continue to monitor it until I do. What can I expect if and when I do start experiencing symptoms?

Dear Reader: Aortic regurgitation is a condition in which the aortic valve in the heart isn’t closing properly. The aortic valve separates the left ventricle, which is the lower pumping chamber of the heart, from the aorta. When functioning properly, it’s a one-way valve that closes completely between heartbeats. As with the other three cardiac valves, the main job of the aortic valve is to maintain the one-way flow of blood through the heart.

When someone has aortic regurgitation, the valve isn’t closing tightly. This allows a portion of the oxygen-rich blood, which the left ventricle had just pushed into the aorta during a heartbeat, to flow back into the chamber as the ventricle relaxes. The leakage interferes with optimal blood flow through the heart and throughout the body.

As a result of inadequate blood flow, which delivers oxygen to the tissues of the body, people with aortic regurgitation can become easily fatigued and out of breath. In order to compensate for the glitch in the system, the heart will begin to work harder. Over time, this can cause the left ventricle to become enlarged. It can also cause a condition known as hypertrophy, which is when the walls of the ventricles thicken due to the extra work they’re being asked to do. These structural changes make the left ventricle less efficient and add to the burden on the heart.

Eve Glazier, M.D. and Elizabeth Ko, M.D

Aortic regurgitation is often symptom-free when it is mild. It is typically detected when a physician listens to the heart and hears the tell-tale sounds of a leaky valve. As the condition begins to worsen, symptoms can include the fatigue and shortness of breath that we mentioned, as well as chest pain, irregular heartbeat, swelling in the feet and ankles and difficulty breathing when lying down. These are what your physician will be looking for. In more severe cases, diastolic blood pressure -- that’s the bottom number -- becomes low and is often accompanied by a forceful heartbeat, known as a “bounding” pulse. Some people may experience severe light-headedness that can lead to fainting.

The decision to monitor your condition without a surgical intervention at this time is known as watchful waiting. In making that choice, a cardiologist weighs a number of factors. These include the severity of the individual’s condition, the appearance of their heart as obtained through scans, and the person’s general health. When someone does need surgery to repair or replace an aortic valve, it can often be done via a catheter that is threaded through a vein. Although this is a minimally invasive procedure, it’s still surgery and, therefore, carries some risks.

If you begin experience any of the more advanced symptoms that we have discussed, it’s important to seek out immediate medical care.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)


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