Definition:

Aortic regurgitation, also known as aortic insufficiency, is a valve condition which the structure of the aortic valve is altered in such a way that blood is allowed to leak back from the aorta into the left ventricle when the aortic valve is "supposedly closed."  This causes the volume load in the left ventricle to increase and cause the ventricle to dilate and eventually fail, causing pulmonary congestion.  Causes include: idiopathic aortic root dilitation (seen with elders, hypertension, and bicuspid aortic valves), rheumatic heart disease (in patients with history of rheumatic fever), infective endocarditis (an infection on the valve causing perforation/destruction), Marfan's syndrome (genetic disorder causing cystic medial necrosis and aortic root dissection), aortic dissection, syphilis (which can produce inflammation of the aorta), and lupus.

Symptoms:

• Palpitations due to arrhythmias
• Shortness of breath - on exertion, lying flat, and sleeping at night [left-sided heart failure]
• Syncope
• Angina - chest pain

Diagnosis:

• Physical exam - diastolic blowing murmur on stethoscope, Corrigan's pulse, Hill's sign, pistol-shot femoral pulses, Duroziez's sign, de Musset's sign, Quincke's pulse
• Chest X-Ray - to evaluate heart enlargement and aorta dilation
• EKG - to look at heart rhythm, may see evidence of left ventricle hypertrophy
• Echocardiography - to look at abnormal blood flow across the aortic valve when it is closed
• Cardiac catheterization - to evaluate degree of insufficiency and look at coronary artery stenosis

Treatment:

• Aortic valve replacement once criteria are met
• If surgery is not possible, symptomatic relief with digitalis, diuretics, and vasodilators