Aortic insufficiency is the valve defect or disease of heart characterized by improper closure of the aortic valve of the heart. Improper closure of aortic valve pushes the blood back to the left ventricles during ventricular diastole. Usually aortic valve deteriorate or weakens unable to produce the tight closure of the valve.
Aortic insufficiency is also called as the aortic regurgitation or aortic incompetence.
Aortic valve is the valve present between the left ventricle and the aorta – (main artery supplying pure blood to body). Valve has the tight leaflet connected to aorta by a ring structured annulus. Blood flows by opening the leaflet only in one direction from left ventricles to the aorta. Any defect in this valve leaking blood leads to aortic insufficiency.
Causes and risk factors for aortic insufficiency:
The cause for insufficiency is mainly the weakness in the aortic valve. Various risk factors and cause for aortic insufficiency are as follows
- Congenital heart defect – the valve defect seen right from birth due to malformations of the leaflets.
- High blood pressure – severe increase in blood pressure for long period of time will dilate the aortic root present above the aortic valve leading to aortic insufficiency.
- Ageing – the wear and tear of valve continues all day long, so as the person ages valve defects are likely to occur.
- Direct injury – any accidental injury to the chest regions affecting the aortic valve directly.
- Rheumatic fever – makes the leaflets of valve to be inflamed and leaky.
- ANKYLOSING SPONDYLITIS – a spinal disorder with chronic inflammation in the spinal bones and its joints. This inflammation acquired person has about 45% chance of aortic valve defect.
- ENDOCARDITIS – this is the inflammation of the endothelial lining of the heart muscles mainly affecting the heart valves.
- Syphilis – is the sexually transmitted infection has some influence on the aortic valves.
- Rheumatic heart disease
- Degenerative vascular disease – unexpected injury to the walls of aorta dilating the aortic root.
- MARFAN syndrome – a genetic disorder of the connective tissues leads to cause of aortic valve defects.
- REITER’s syndrome – a response to the infection spreading in any parts of the body. This as chronic condition will cause aortic regurgitation
Signs and symptoms:
Most commonly seen Symptoms are
- Heart palpitation – irregularity in heart beat, particularly seen in the lying position.
- Chest pain – frequently experienced by physical action.
- Chest tightness leading to shortness in breathing process.
- Difficulty in breathing often in the night times.
- Bounding pulse – pulse felt at forceful rate easily felt with slight pressure.
- Exertion on slight exercise
These symptoms are also seen in the other heart diseases. Other conditions should be ruled out by careful diagnosis and tests.
The doctors determine the diagnosis of aortic insufficiency by the symptoms seen and physical examination and other tests as follows
- Chest x – ray – shows the size of the lungs and heart and their structures.
- ECG – electrocardiogram – shows the electrical activities in the heart muscles and their abnormalities to determine the
- Echocardiogram – shows the structures and size of the heart to detect the accurate reason for pathology behind insufficiency.
- Exercise tolerance test – show the excitability of the aortic insufficiency in the exercise programs. The function capabilities are detected.
- Cardiac catheterization – injecting dye into the artery and it shows the heart damages.
- CT scan and MRI scan – shows the images of the heart structures especially the valves for their defects.
Various medications are available for the control of aortic insufficiency. The main aim of medications is to decrease the work load of heart and reduce the stress level on the walls of the left ventricles. Mostly used medications are as follows
- Vasodilators – HYDRELAZINE
- Diuretics – to reduce the excess fluid buildup in the body.
- ACE inhibitors
- ANGIOTENSIN 2 receptor antagonist
- Calcium channel blockers – NIFEDIPINE
- Nitroglycerin for chest pain
- Anti-arrhythmic drugs.
When the aortic insufficiency is not responding to the medications listed above, surgery is recommended by doctors. The main surgery undergone is the aortic valve replacement surgery. The old valve is replaced by a new prosthetic valve. Most commonly the surgery is done by open heart surgery technique.
Aortic insufficiency can lead to other heart problems and can be caused by other heart disease and after their treatments. It is closely associated with other diseases. In diagnosis other diseases should be ruled out.