How to Diagnose Aortic Regurgitation

Three Parts:Recognizing Signs and SymptomsReceiving Diagnostic TestsTreating Aortic Regurgitation

Aortic regurgitation is when the aortic valve (one of your heart valves) becomes weakened, and allows some of the blood to flow back into your heart after having been pumped out into the body. It can be diagnosed by recognizing signs and symptoms, as well as by receiving a series of tests and examinations from your doctor (including a likely referral to a cardiologist — a heart specialist). Fortunately, if aortic regurgitation becomes severe, it can be treated surgically with either a valve repair or a valve replacement, depending upon the extent of damage.

Part 1
Recognizing Signs and Symptoms

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    Watch for symptoms that may be indicative of aortic regurgitation.[1] Aortic regurgitation occurs when the heart valve leading from the left ventricle of your heart to the aorta becomes weakened. As a result, some of the blood that is pumped out of the heart flows back in after each heartbeat, due to incomplete closure of the aortic valve. Initially, you likely will not notice any signs or symptoms of aortic regurgitation. It is only once the condition progresses and gets more severe that symptoms become apparent. Some symptoms to be on the lookout for that may indicate aortic regurgitation include:
    • Fatigue, particularly unusual fatigue with exertion
    • Fainting or lightheadedness
    • Palpitations (feeling your heart beating)
    • In more severe cases: shortness of breath, chest pain, swelling of the feet and ankles. If you experience these symptoms, this is a medical emergency and you should seek immediate medical attention.
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    See your doctor if you believe you may be experiencing aortic regurgitation.[2] If you are experiencing the signs and symptoms above, it is best to book an appointment with your family doctor sooner rather than later — or, in certain cases, seek emergency care. Your doctor will likely refer you to a cardiologist (a heart specialist) who can proceed with further diagnostic and investigative tests.
    • Note that sometimes aortic regurgitation presents with no signs or symptoms until you begin to experience the complication of congestive heart failure.
    • Signs and symptoms of congestive heart failure include: swelling of your ankles and feet, shortness of breath, fatigue, and occasionally chest pain.
    • Depending upon the severity of your congestive heart failure symptoms, either proceed straight to the Emergency Room (if you are experiencing severe shortness of breath or chest pain), or book an appointment in the next day or so with your family doctor to receive appropriate medical evaluation and treatment.
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    Have your doctor check your pulse.[3] If you suspect that you may have aortic regurgitation, your doctor will look for what is called a "bounding pulse." A bounding pulse occurs when your systolic blood pressure (the force of blood against the artery walls when your heart contracts) is significantly higher than your diastolic blood pressure (the force of blood against the artery walls when your heart relaxes).
    • A bounding pulse is most easily detected at the carotid artery on the left side.
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    Measure your blood pressure.[4] If you have aortic regurgitation, your systolic blood pressure will likely be normal but your diastolic blood pressure (the pressure when your heart relaxes) will likely be lower than normal. Your doctor will measure your blood pressure in the office, and will check to see whether your diastolic blood pressure (the bottom number) is low.
    • If it is low, this may be a sign that you have aortic insufficiency, and your doctor will proceed with further tests and investigations.

Part 2
Receiving Diagnostic Tests

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    Have your doctor listen to your heart with a stethoscope.[5] If you have aortic regurgitation, your doctor will likely be able to pick up a heart murmur when she listens to your heart with a stethoscope. The heart murmur is due to the backflow of blood from your aorta (the blood vessel) back into your left ventricle (a chamber of your heart) due to weakness of the aortic valve.
    • It will be a "diastolic murmur" that your doctor is looking for, meaning that the hum of the murmur will be audible as your heart relaxes (and when the blood flows back into your heart due to aortic valve weakness).
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    Obtain an electrocardiogram. Your doctor will also order an electrocardiogram (EKG or ECG) to check the rhythm of your heart, look for signs of decreased or lack of blood or oxygen in the heart, and exclude other causes of the symptoms.[6] Electrical information will be transmitted through electrodes stuck to your skin. You may be required to stay still and/or to walk on a treadmill or pedal a stationary bike.[7]
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    Receive an echocardiogram to evaluate your aortic valve.[8] An echocardiogram is a type of ultrasound that specifically looks at your heart. It will be able to evaluate the size and function of your heart, as well as illustrating to your doctor the direction of blood flow in the heart and the function of each of the valves.
    • If your aortic valve is malfunctioning, the echocardiogram will show blood flowing backwards into the heart after each contraction.
    • An echocardiogram may be used to officially diagnose aortic regurgitation and provide an indication of the severity of the problem (mild, moderate, severe).
    • It may also be used as a tool to monitor aortic regurgitation (or other heart disorders), so that your doctor knows when further intervention or treatment is needed.
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    Opt for an exercise stress test.[9] An exercise stress test normally consists of going on a treadmill and gradually increasing the intensity (beginning at a slow walk and proceeding to a jog or a run) until you are too fatigued to continue, or until your heart begins to show signs of stress as per the measuring devices you will be hooked up to. The purpose of an exercise stress test is to watch how your heart responds under the stress of physical exertion, and to draw conclusions based upon that about your overall heart function.
    • If you have aortic regurgitation, your heart will be less capable than normal at responding to the stress of exertion.
    • You will likely fatigue sooner, and your heart will begin to show signs of stress due to the inability to pump enough blood fast enough (as a result of the backflow of blood into the heart due to a leaky valve).
    • By these measures, an exercise stress test can aid in the diagnosis of aortic regurgitation.
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    Ask your doctor for a cardiac MRI.[10] A cardiac MRI is another way for doctors to visualize your heart and to see abnormalities. Abnormalities that may be present in cases of aortic regurgitation include an enlarged left ventricle (the biggest chamber of the heart becomes enlarged due to the backflow of blood causing stress on the heart), as well as changes to the aortic valve and to the aorta (the big blood vessel leaving the heart).
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    Have a chest x-ray to evaluate for fluid in the lungs and/or an enlarged heart.[11] Another test that can help in the diagnosis of aortic regurgitation is a chest x-ray. In more severe cases of aortic regurgitation, you may begin to develop an enlarged heart and/or fluid in the lungs due to the pressure of having too much blood in the heart at one time. These are complications of aortic regurgitation that can be picked up with a chest x-ray.
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    Obtain a referral for cardiac catheterization.[12] If the above tests are inconclusive as to the degree of aortic regurgitation you are experiencing, your doctor may order a more invasive test called cardiac catheterization. In this test, a tube is inserted through an artery in your arm or leg and passed through that artery until it reaches the heart. Once it is at the heart, dye is injected. An x-ray machine is then used to visualize the motion of the dye and, in cases of aortic regurgitation, this can inform your doctor as to the degree and seriousness of your regurgitation, allowing your doctor to make the best treatment decisions for you moving forward.

Part 3
Treating Aortic Regurgitation

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    Opt for "watchful waiting" and regular echocardiograms.[13] If your aortic regurgitation is not too severe, your doctor or cardiologist may recommend that you do not opt for any procedures (such as surgery), but rather, that you continue to monitor your aortic valve over time and treat it surgically only if that becomes necessary. You will be advised to receive regular echocardiograms to check the status and function of your aortic valve, and it is important that you follow through with these appointments as a decline in function of your aortic valve may not be noticeable to you otherwise.
    • Your doctor may also advise caution with exertion, and avoiding strenuous activities so as not to put undue stress on your heart and your aortic valve.
    • You will likely be advised to continue with moderate physical activity due to the numerous health benefits that this offers.
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    Take medications to prevent worsening of your symptoms.[14] If your blood pressure is high, your doctor will recommend that you take blood pressure medications to lower it back into the normal range. This is because elevated blood pressure is one of the major risk factors for worsening aortic regurgitation.
    • If you are experiencing symptoms of congestive heart failure as a result of your aortic regurgitation, you may receive "ACE inhibitors" and or "diuretics" (two classes of medications) to help with symptom relief and to get rid of excess fluid in your body.
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    Receive surgery to "cure" aortic regurgitation.[15] The one and only definitive "cure" for aortic regurgitation is to have it treated surgically. This can be done either with an aortic valve repair, or an aortic valve replacement (depending upon the extent of damage to the valve). Most often, for aortic regurgitation, a full aortic valve replacement will be required.[16]
    • For the surgery, you will be put under general anesthetic, which means that you will not be conscious for the operation.
    • You will receive open heart surgery and your aortic valve will be replaced with a new valve.
    • Recovery time following surgery usually involves one week in the hospital, followed by four to six weeks of rest at home prior to returning to work. You may need anticoagulation after the surgery to maintain valve function.

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Categories: Cardiovascular Health and Blood Pressure