Aortic Regurgitation

Overview

Aortic regurgitation is a heart valve condition in which the aortic valve does not close properly. The aortic valve sits between the heart’s main pumping chamber, the left ventricle, and the aorta, the large artery that carries oxygen-rich blood to the body. When the valve leaks, some blood flows backward into the heart instead of moving forward to the body.

Over time, this backward flow can make the left ventricle work harder. The chamber may enlarge or weaken if the leak is significant or continues for many years. Aortic regurgitation can be mild and stable, or it can become more serious and require close monitoring or treatment. Some people have no symptoms for a long time, which is why medical evaluation and follow-up are important.

Symptoms

Symptoms of aortic regurgitation often develop gradually, especially when the condition is chronic. In mild cases, there may be no noticeable symptoms. When symptoms do occur, they may include:

• Shortness of breath during activity or when lying down
• Fatigue or reduced ability to exercise
• Awareness of the heartbeat, such as pounding or fluttering sensations
• Chest discomfort, pressure, or tightness
• Dizziness or fainting, especially with exertion
• Swelling in the ankles, feet, or abdomen
• Waking at night feeling short of breath

In acute aortic regurgitation, which develops suddenly, symptoms can be more severe and may progress quickly. Sudden breathlessness, severe weakness, chest pain, or fainting should be treated as urgent symptoms.

Causes and Risk Factors

Aortic regurgitation may occur because of a problem with the valve leaflets, the aorta, or both. The valve may be damaged, stretched, or unable to meet correctly when it closes. Common causes and contributing factors include:

• A valve present from birth, such as a bicuspid aortic valve, which has two leaflets instead of the usual three
• Age-related changes that affect the valve structure
• High blood pressure, which can place extra strain on the aorta and valve
• Enlargement of the aorta near the valve
• Infection of the heart valve, known as infective endocarditis
• Inflammatory or connective tissue conditions that affect the aorta or heart valves
• Previous chest injury or certain heart procedures
• History of rheumatic fever in some regions

Risk can be influenced by underlying heart conditions, family history of aortic disease, long-standing high blood pressure, and certain inherited connective tissue disorders. Not every person with these factors will develop aortic regurgitation, but they may benefit from medical monitoring.

Diagnosis

Aortic regurgitation is diagnosed through a medical assessment and heart tests. A doctor may ask about symptoms, medical history, family history, and any previous heart conditions or infections. During a physical examination, the doctor may listen for a heart murmur, which is an unusual sound caused by turbulent blood flow through the valve.

Tests that may be used include:

• Echocardiogram, an ultrasound of the heart that shows valve movement, blood flow, heart chamber size, and pumping function
• Electrocardiogram, which records the heart’s electrical activity
• Chest imaging to assess heart size and the aorta
• Cardiac magnetic resonance imaging or computed tomography in selected cases to view the aorta and heart structure in more detail
• Exercise testing in some patients to evaluate symptoms and heart response during activity

The severity of aortic regurgitation is usually described as mild, moderate, or severe. Diagnosis also includes assessing how well the heart is coping with the leak. This helps guide follow-up and treatment planning.

Treatment Options

Treatment depends on the severity of the valve leak, symptoms, heart function, the size of the aorta, and the person’s overall health. Mild aortic regurgitation may only require regular check-ups and repeat imaging to monitor the valve and heart over time.

When aortic regurgitation is more significant, treatment may focus on reducing strain on the heart, managing related conditions such as high blood pressure, and monitoring for changes in symptoms or heart size. Lifestyle measures recommended by a healthcare professional may include heart-healthy eating, appropriate physical activity, avoiding smoking, and managing other cardiovascular risk factors.

If the valve leak is severe, if symptoms develop, or if the heart begins to enlarge or weaken, a procedure may be considered. Options can include repairing the aortic valve, replacing the valve, or treating an enlarged section of the aorta when needed. The most suitable approach depends on the valve anatomy, the condition of the aorta, surgical risk, and individual patient factors.

People with aortic regurgitation often need long-term follow-up with a cardiology team. Regular monitoring can help detect changes early and support timely treatment decisions.

When to See a Doctor

Seek medical advice if you experience ongoing shortness of breath, reduced exercise capacity, unexplained fatigue, palpitations, chest discomfort, dizziness, or swelling in the legs. These symptoms can have many causes, but they should be assessed by a healthcare professional.

Urgent medical attention is needed for sudden or severe shortness of breath, chest pain, fainting, confusion, or symptoms that worsen rapidly. People already diagnosed with aortic regurgitation should attend scheduled follow-up visits and report any new or changing symptoms promptly.

Early evaluation can help clarify the cause of symptoms, assess the heart valve and heart function, and guide the most appropriate care plan.

Frequently Asked Questions

What is aortic regurgitation?

Aortic regurgitation is a heart valve condition in which the aortic valve, which sits between the heart's main pumping chamber and the aorta, does not close properly. Some blood flows backward into the left ventricle instead of moving forward to the body. Over time this extra volume makes the ventricle work harder, and the chamber may enlarge or weaken if the leak is significant or continues for many years. It can be mild and stable or progressive.

What are the symptoms of aortic regurgitation?

Symptoms often develop gradually in chronic disease, and mild cases may cause none. When present they include shortness of breath during activity or when lying down, fatigue, reduced exercise capacity, awareness of a pounding or fluttering heartbeat, chest discomfort, dizziness or fainting with exertion, swelling of the ankles, feet or abdomen and waking at night breathless. Acute aortic regurgitation causes sudden severe breathlessness, weakness, chest pain or fainting and needs urgent care.

What causes aortic regurgitation?

The leak may arise from the valve leaflets, the aorta or both. Causes include a bicuspid aortic valve present from birth with two leaflets instead of three, age-related valve changes, long-standing high blood pressure, enlargement of the aorta near the valve, infection of the valve known as endocarditis, inflammatory or connective tissue conditions such as Marfan syndrome, previous chest injury or heart procedures and rheumatic fever in some regions.

How is aortic regurgitation diagnosed?

A doctor may first hear a heart murmur during a physical examination. The key test is an echocardiogram, an ultrasound of the heart that shows valve movement, the severity of the leak, chamber size and pumping function. An electrocardiogram records electrical activity, chest imaging assesses heart size and the aorta, and cardiac MRI or CT is used in selected cases to view the aorta and heart in more detail. Exercise testing may evaluate symptoms during activity.

How is aortic regurgitation treated?

Treatment depends on severity, symptoms and the effect on the left ventricle. Mild or moderate disease is usually monitored with regular echocardiograms, blood pressure control and treatment of any underlying cause. When regurgitation is severe with symptoms or with signs that the ventricle is enlarging or weakening, valve repair or replacement is recommended, performed by open surgery or, in selected patients, by minimally invasive or catheter-based techniques. Aortic enlargement may be repaired at the same time.