Aortic Valve Insufficiency

What is aortic valve insufficiency?

Aortic valve insufficiency results from damage to the aortic valve. It is also called aortic regurgitation or aortic insufficiency. It has a male gender predilection as it is commoner in men than women.

The aortic valve is that one valve that is responsible for sending blood which is pumped in the heart to the body systems. This blood that passes through it is usually oxygen-rich and contains a whole lot of other nutrients that is being sent to the body.

When there is a problem with the aortic valve that does not permit closure, there will be a backflow of blood into the left ventricle. This condition ensures that the left ventricle always has blood in it even before receiving blood flow from the left atrium.

It, therefore, means that for the left ventricle to be able to contain this much amount of blood, it must undergo some stretch. The cardiac myocytes (heart muscle cells) need to increase its work level and pump out more blood. This additional work makes the heart strained and causes an elevation in the blood pressure. Irrespective of all these maneuvers, the heart is still unable to pump enough blood to meet the oxygen and nutritional needs of the body. This condition can be debilitating and it makes one get fatigued easily with associated shortness of breath.

Symptoms of aortic valve insufficiency

Aortic valve insufficiency may remain asymptomatic for many years. The symptoms when they occur may be sudden in onset and this happens as the injury continues. The symptoms that should be watched out for in this condition include:

  • Chest discomfort that may either be painful or causing chest tightness that worsens with exertion and is relieved by resting
  • Excessive tiredness
  • Palpitations
  • Difficulty in breathing when lying down
  • Shortness of breath
  • Feeling weak
  • Fainting
  • Swollen ankles and feet

Causes of aortic insufficiency

Formerly, Rheumatic fever was the one cause that was known to be a common culprit but with the advances in technology, other common causes have been identified. These causes include:

  • Congenital heart defects: these are heart defects that one is born with
  • Infection of the tissues of the heart
  • Hypertension
  • Genetic conditions such as Marfan’s syndrome which is a connective tissue disease
  • Syphilis that is left untreated
  • Lupus
  • Heart aneurysms
  • Ankylosing spondylitis which is arthritis that is inflammatory

Diagnosis

To make a diagnosis of any condition, a proper history is to be taken, appropriate general physical and systemic examinations done, investigations to help confirm the diagnosis and general investigations.

For aortic valve insufficiency, the doctor gets a full medical history, listens to the heart, checks the blood pressure and examines the pulse while watching out for possible pointers to heart conditions which include:

  • A heartbeat that is strangely forceful
  • Visible neck pulsation
  • Water-hammer pulse which is a pulse that is pounding in character and is pathognomonic of aortic insufficiency
  • Sounds of blood leakage from the aortic valve

Diagnostic tests may be ordered for after examination. It includes the following:

  • Chest X-ray: can help identify cardiomegaly which is a heart enlargement. Cardiomegaly is usual in aortic valve insufficiency
  • Electrocardiogram: it measures the electrical activity of the heart including the heart rate and rhythm
  • Echocardiogram: this visualizes the heart compartments and valves
  • Cardiac catheterization: measures the pressure in the different heart chambers and assesses the blood flow through the chambers.

These tests when done assist the doctor to confirm a suspected diagnosis, give the degree of damage, and help one to agree on the best treatment modality.

Treatment for aortic valve insufficiency

For cases that are not very serious, activities that promote the health of the heart are to be done. They include

  • Weight loss
  • Exercising
  • Eating a balanced diet

The above life style modifications help to reduce the strain on the heart, lower the blood pressure and decrease the likelihood of developing complications.

For more severe cases, a surgery directed at repairing or replacing the aortic valve is recommended. The aortic valve surgeries available are valve replacement or valvuloplasty which means valve repair. For valve replacement, the aortic valve is removed and substituted with that from a human (cadaveric) donor or that from animal sources such as cows or pigs. The two forms of surgery will mostly need open-heart surgery with a recovery period that may be a bit long. Other times, an endoscopy can be used to perform the surgery, or even through a tube that is put into the body. This actually makes the recovery time shorter.

Long term outlook

The prognosis of an aortic valve after the repair is usually good but you must be very careful and watch out for infections that may affect the heart valves such as Rheumatic fever and Endocarditis. Those who have had an aortic valve disease and had it repaired have a higher chance of needing surgery in the case of a heart infection than those who still have their original valves.

Dental diseases, dental procedures and strep throat can lead to heart infections. Ensure that your oral hygiene and care is good and seek a medical care urgently in the case of a dental condition or serious sore throat. 

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