Aortic Valve Regurgitation (Backflow)

________________________________________________________________________

KEY POINTS

• Aortic valve regurgitation means the aortic valve in your heart does not close completely between heartbeats. Your heart must work harder to pump blood to your body. Your heart can get larger, thicker, stiffer, and stop working well.
• Treatment may include medicines or surgery to replace the heart valve.
• It is important for you to quit smoking, exercise as your provider recommends, eat a healthy diet, and watch your weight and blood pressure. You also need to lessen stress in your life, and protect yourself against infections.

________________________________________________________________________

What is aortic valve regurgitation?

Aortic valve regurgitation is a problem with the aortic valve in your heart. The aortic valve is located between the lower left side of your heart and the big blood vessel (aorta) that carries blood to the rest of your body. Before each beat, the left side of your heart fills with oxygen-rich blood that has passed through your lungs. Then your heart muscle squeezes to push blood into your aorta and out to the rest of your body. When blood pushes against the aortic valve, the valve opens. At the end of the squeeze, the valve normally closes tightly, so that no blood flows backwards into your heart.

When you have valve regurgitation, the valve does not close completely between heartbeats. This lets blood in the aorta flow back into your heart. When this happens, your heart must work harder to pump blood to your body. This makes the heart larger and thicker. It may become stiff and stop working well.

What is the cause?

Aortic valve regurgitation can happen quickly or it can happen slowly over time. When it happens quickly, it is called acute. A heart valve infection, a chest injury, or a tear in your aorta may cause acute regurgitation.

If the regurgitation happens slowly over time, it is called chronic. The most common cause of chronic regurgitation is high blood pressure. Other common causes are aging, rheumatic fever, and valve problems that you were born with.

What are the symptoms?

When the regurgitation happens fast, your heart cannot keep up with your body's need for blood. As blood flows back into the heart, fluids may collect in your lungs and other body tissues, making it hard to breathe. You can get sick very quickly and need surgery right away.

Chronic regurgitation rarely causes symptoms. Over several years, the added work on the heart can cause symptoms such as:

• Shortness of breath or chest pain when you exert yourself
• Discomfort when you are lying down
• Waking up at night feeling very short of breath

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. He or she will listen to your heart for a sound called a murmur. Your provider will also listen for changes in the sounds normally heard when your blood pressure is checked.

Tests may include:

• A chest X-ray
• An ECG (also called an EKG or electrocardiogram), which measures and records your heartbeat
• An echocardiogram, which uses sound waves (ultrasound) to see how well your heart is pumping and to look at the valves
• A Doppler exam, which uses sound waves (ultrasound) to look at the blood flow in your blood vessels
• Heart catheterization, which uses a small tube called a catheter inserted into a blood vessel, dye, and X-rays to show how blood flows through the aortic valve

How is it treated?

Acute regurgitation is usually an emergency. It must be quickly treated, usually with surgery to put in a new valve.

If you have chronic regurgitation, your heart is only mildly enlarged, and you have few or no symptoms, you may be treated with medicines to:

• Help get rid of extra fluid
• Lower blood pressure so the heart does not have to work as hard

If tests show that your heart muscle is getting weak, you may need surgery to replace the damaged valve with an artificial valve. Two types of artificial heart valves are available:

• Mechanical valves are made completely from man-made materials. When you have a mechanical valve, you must take blood-thinning drugs for the rest of your life to reduce the risk of blood clots. The main advantage of mechanical valves is that they usually last 20 years or more.
• Biological valves are made from human or animal tissue. The main advantage of a biological valve is that you do not need to take blood-thinning drugs for the rest of your life. These valves usually last up to 15 years.

Surgery to replace the aortic valve can improve both the quality and length of your life.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider.

A healthy lifestyle may also help:

• Eat a healthy diet. Ask your provider about the benefits of talking to a dietitian to learn what you need in a healthy diet.
• Try to keep a healthy weight. If you are overweight, lose weight.
• Stay fit with the right kind of exercise for you.
• Limit caffeine.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• If you smoke, try to quit. Talk to your healthcare provider about ways to quit smoking.
• If you want to drink alcohol, ask your healthcare provider how much is safe for you to drink.
• Try to get at least 7 to 9 hours of sleep each night.

Ask your healthcare provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

Tell all healthcare providers you see that you have aortic valve regurgitation. Although rare, damaged, abnormal, or artificial heart valves can be more likely to get infected by bacteria, which can cause severe problems. Ask your healthcare provider if you should take an antibiotic before any kind of dental work or surgery. This includes having your teeth cleaned or procedures involving the bladder, vagina, or rectum.

How can I help prevent aortic valve regurgitation?

If you have high blood pressure, make sure your blood pressure is under control. Follow your healthcare provider's instructions about exercise, diet, and medicines.