Aortic valve insufficiency (AVI), is also called aortic insufficiency or aortic regurgitation. This condition indicates damage to the aortic valve. AVI affects one out of every 10,000 people between the ages of 30 and 60. The condition is more common in men than women. To better understand this disease, it helps to understand how the aortic valve works.
The aortic valve is the final valve the blood passes through when it exits the heart, full of fresh oxygen and nutrients to be delivered to the rest of your body. So what happens if the valve doesn’t work properly?
When the aortic valve doesn’t close all the way, some of the blood flows backward instead of out to the aorta and the body. This means the left ventricle never quite empties of blood before the next load of blood arrives from the left atrium.
As a result, the left ventricle must expand its normal capacity to accommodate the leftover blood and the new blood, and the heart muscle has to work extra hard to pump out the blood. The extra work strains the heart muscle and raises the blood pressure in the heart.
Despite all the extra effort, the heart still cannot pump enough blood to keep the body well-oxygenated. This is why you feel tired and are easily out of breath. Over time, these circumstances begin to take a serious toll on your heart and overall health.
In the past, rheumatic fever was a common cause of damage to the heart valves. Today, we know of many other causes, including:
- congenital valve defects (those you are born with)
- infections of the heart tissue
- high blood pressure
- genetic conditions such as Marfan syndrome (affects the connective tissues)
- untreated syphilis
- systemic lupus erythematosus, usually just known as lupus, is an autoimmune disease
- heart aneurysms
- ankylosing spondylitis, a form of inflammatory arthritis
Aortic valve insufficiency can be present without many noticeable symptoms for a number of years. As the damage progresses, the symptoms can appear suddenly, including:
- chest pain or tightness that increases with exercise and subsides when you are at rest
- heart palpitations
- shortness of breath
- difficulty breathing when lying down
- swollen ankles and feet
Diagnostic tests for aortic insufficiency generally include an office exam, X-rays, diagnostic imaging, and cardiac catheterization.
The Office Examination
Your doctor will take a complete medical history, listen to your heart, take your pulse and blood pressure, and look for indicators of heart valve problems, such as:
- a wide difference between the systolic and diastolic blood pressure readings
- an unusually forceful heartbeat
- visible pulsing of the neck artery
- “water-hammer” pulse, a pounding pulse typical of aortic insufficiency
- sounds of blood leaking from the aortic valve
Diagnostic Imaging Tests and Cardiac Catheterization
After the initial exam, you may be referred for other diagnostic tests, including:
- chest X-ray to spot enlargement of the left ventricle typical of heart disease
- electrocardiogram (ECG) to measure the electrical activity in the heart, including the rate and regularity of heartbeats
- echocardiogram to view the condition of the heart chambers and heart valves
- cardiac catheterization to assess the pressure and flow of blood through the heart chambers.
These tests allow your doctor to confirm the diagnosis, determine the extent of damage, and decide on the most appropriate treatment.
In mild cases, your doctor may just recommend regular heart monitoring and improving your health habits to reduce the load on your heart. Losing weight, exercising, and a healthy diet can reduce blood pressure and lower your chances of complications.
In more advanced cases of aortic disease, surgery to repair or replace the aortic valve may be necessary. Two types of aortic valve surgery are valve repair (valvoplasty) and valve replacement. Valve replacement can use a mechanical valve, or one from a pig, cow, or human cadaver.
Both surgeries may require open-heart surgery with a fairly lengthy recovery period. In some cases, the surgery can be performed endoscopically (through a tube inserted into your body), which greatly reduces recovery time.
Once your aortic valve is repaired, your prognosis is generally good. However, you will always need to guard against and respond quickly to any type of infections, as they could spread to your heart.
Both dental disease and strep throat can cause heart infections. You should practice good oral hygiene and get immediate medical help for any dental problems or severe sore throats that arise.