Aortic regurgitation awareness

Overview

Aortic regurgitation is a condition where the aortic valve in your heart does not close tightly, allowing some blood to leak backward into the heart instead of moving forward to the body. Over time, this extra work can weaken the heart muscle.

Aortic regurgitation is not very common, but it is one of the more common heart valve problems. It affects about 1 in 100 people, and the risk increases with age.

It can affect people of any age, but it is most often seen in older adults. Men are slightly more likely to have it. Some people are born with a bicuspid aortic valve (two flaps instead of three), which raises the risk.

Symptoms

Common symptoms

• Shortness of breath, especially during activity or when lying flat
• Fatigue or feeling unusually tired
• Heart palpitations (feeling like your heart is pounding, racing, or skipping beats)
• Chest pain or tightness, often during exercise
• Swelling in the ankles, feet, or legs (fluid buildup)

Symptoms in children

• Poor feeding and difficulty gaining weight in infants
• Rapid breathing or breathlessness during feeding or crying
• Frequent respiratory infections
• Failure to thrive (not growing as expected)

Symptoms in older adults

• Symptoms may be mistaken for normal aging, such as increased fatigue or shortness of breath with activity
• Dizziness or fainting spells
• Chest discomfort that comes and goes

Causes

Main causes

• High blood pressure (hypertension) – puts extra stress on the aortic valve
• A bicuspid aortic valve (born with two flaps instead of three) – more likely to leak
• Infection of the heart valve (infective endocarditis) – can damage the valve
• Rheumatic fever – a complication of untreated strep throat that can scar the valve
• Age-related wear and tear – the valve stiffens and may not close fully
• Connective tissue disorders (e.g., Marfan syndrome) – weaken the valve support

Risk factors

• Being older, especially over 60
• Having a family history of heart valve problems
• High blood pressure that is not well controlled
• History of rheumatic fever or frequent strep infections
• Certain genetic conditions like Marfan syndrome or bicuspid aortic valve

When to see a doctor

See a doctor urgently if:

• If you have sudden chest pain, severe shortness of breath, or fainting – call your local emergency number immediately.
• If you have new, unexplained chest discomfort or heart palpitations that last more than a few minutes – seek same-day care.

Book a routine appointment if:

• If you have mild symptoms like fatigue or slight shortness of breath, make an appointment with your doctor within a few weeks.
• If you have a known heart condition or a history of rheumatic fever, have regular check-ups even without symptoms.
• If you notice swelling in your legs or ankles that does not go away, schedule a visit soon.

Diagnosis

Your doctor will start by listening to your heart with a stethoscope. Aortic regurgitation makes a specific 'blowing' sound (heart murmur). If they hear this, they will likely refer you to a heart specialist (cardiologist) for further tests.

Tests that may be done

• Echocardiogram (echo) – uses sound waves to create a picture of your heart and check how the valve is working
• Electrocardiogram (ECG) – records the electrical activity of your heart to see if it is strained
• Chest X-ray – shows the size and shape of your heart and whether fluid has built up
• Cardiac MRI – gives detailed images of the heart and valves
• Exercise stress test – monitors your heart while you walk on a treadmill to see how it handles activity

What to expect at your appointment

The tests are painless and usually done as an outpatient. You will likely need to see a cardiologist who will explain the results and discuss next steps. If the leak is mild, you may only need regular check-ups every 1-2 years. If severe, treatment may be recommended.

Treatment

Treatment for aortic regurgitation depends on how severe the leak is and whether you have symptoms. The goal is to reduce the heart's extra workload and prevent heart damage. Mild cases may only need monitoring, while more severe cases require medication or surgery.

Self-care at home

• Monitor your symptoms and report any changes to your doctor
• Follow a heart-healthy diet low in salt, saturated fats, and added sugars
• Stay physically active as advised by your doctor
• Manage stress with relaxation techniques like deep breathing or gentle exercise
• Avoid smoking and limit alcohol

Medical treatments

Medications can help control symptoms and reduce strain on the heart. These may include drugs to lower blood pressure, reduce fluid buildup (diuretics), or keep the heart pumping more efficiently. Your doctor will choose medicines based on your specific needs. Never start or stop any medication without talking to your healthcare provider.

When is surgery considered?

Surgery is usually recommended for severe aortic regurgitation when symptoms occur or the heart becomes enlarged. The main options are repairing or replacing the aortic valve. Valve repair is preferred when possible. In some cases, a less invasive procedure called transcatheter aortic valve replacement (TAVR) may be an option. Your heart team will discuss the best approach for you.

Living with this condition

Living with aortic regurgitation means staying on top of your health. Keep all follow-up appointments with your cardiologist. Take any prescribed medications exactly as directed. Listen to your body – if you feel more tired or short of breath than usual, talk to your doctor. Most people can continue normal activities with some adjustments.

Lifestyle tips

• Stay physically active with low-impact activities like walking, swimming, or cycling as your doctor approves
• Avoid heavy lifting or strenuous exertion if your doctor advises
• Get enough rest and manage stress to reduce strain on your heart
• Monitor your weight daily – sudden gain can mean fluid buildup
• Practice good dental hygiene to prevent mouth infections that could spread to your heart

Diet and exercise

Eat a heart-healthy diet: plenty of fruits, vegetables, whole grains, and lean proteins. Limit salt to help control blood pressure and fluid retention. Stay hydrated, but check with your doctor about ideal fluid intake if you have heart failure. Exercise regularly, but always get your doctor's clearance first – moderate activity like 30 minutes of walking most days is often recommended.

Mental health and emotional wellbeing

Living with a heart condition can be stressful and may cause anxiety or depression. It is normal to feel worried about your health. Talk to your doctor if these feelings interfere with daily life. Connecting with others who have similar conditions can also help.

Prevention

Not all cases of aortic regurgitation can be prevented, especially if you are born with a valve abnormality. However, you can reduce your risk by controlling high blood pressure, treating strep infections promptly to prevent rheumatic fever, and maintaining a healthy lifestyle. Avoiding intravenous drug use also lowers the risk of valve infections.

Vaccines

Get recommended vaccinations, including the flu shot and pneumonia vaccine, to reduce the risk of infections that could affect your heart. Ask your doctor which vaccines are right for you.

Screening programmes

There is no routine screening for aortic regurgitation in the general population. However, if you have a family history of heart valve disease or a known bicuspid aortic valve, your doctor may recommend regular echocardiograms to monitor your valve.

Complications

If left untreated

• Heart failure – the heart becomes too weak to pump blood effectively
• Infective endocarditis – a serious infection of the heart valve lining
• Irregular heart rhythms (arrhythmias) – problems with the heart's electrical system
• Blood clots – can lead to stroke or other blockages

Long-term outlook

The outlook for aortic regurgitation is generally good with proper care. Many people live full, active lives for decades after diagnosis. Surgery, if needed, has high success rates and can relieve symptoms and prevent complications. Early detection and regular follow-up are key to a positive outcome.

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