Presentation depends on whether the valvular insufficiency is an acute or a chronic process.

Patients with acute aortic insufficiency have severe dyspnea, signs of cardiogenic shock (tachycardia, hypotension), cyanosis, pulmonary edema, acute heart failure (fatigability and peripheral edema) and chest pain if coronary or aortic dissection is the cause of the regurgitation [1].

Chronic aortic insufficiency leads to palpitations and dyspnea which is initially exertional and afterward occurs with minimal efforts and chest pain if coronary perfusion is compromised. As the disease progresses, orthopnea and paroxysmal nocturnal dyspnea start to occur. Angina is predominantly nocturnal in these patients. As with all valvular diseases, aortic insufficiency is prone to endocarditis, manifesting as fever and central or peripheral embolism.

Auscultation reveals single S1 and S2 sounds and a diastolic descrescendo, high-pitched murmur that increases with squatting. Systolic blood pressure tends to increase, while the diastolic component is prone to decrease.

Chronic aortic insufficiency, but not the acute form, is accompanied by several peripheral signs, reflecting increased stroke volume and wide pulse pressure: pulsation of the liver (Rosenbach), spleen (Gerhardt), retinal arterioles (Becker), cervix (Shelly), uvula (De Musset), capillaries of the nail bed (Quincke), systolic contraction and diastolic dilation of the pupil (Landolfi). In aortic insufficiency, auscultation of the femoral artery reveals systolic and diastolic sounds (Traube) and bruits if the artery is slightly compressed (Duroziez). The "water-hammer" pulse is known as Corrigan's sign, while De Musset's sign describes a specific bobbing motion of the head with each cardiac cycle. When popliteal blood pressure is at least 60 mm Hg higher than the brachial one, Hill's sign is present and if diastolic brachial pressure decreases by at least 15 mm Hg when the arm is raised above the head, Mayne's sign should be noticed. As symptoms worsen, so does the prognosis [2].

• Fatigue

  See your doctor if you have fatigue, shortness of breath, and swollen ankles and feet, which are common symptoms of heart failure. Causes Your heart has four valves that keep blood flowing in the correct direction. [mayoclinic.org]

  Symptoms can include fatigue, fainting, shortness of breath, palpitations (sensation of the heart beating), and swelling of the feet, legs, or abdomen. [uabmedicine.org]

  Stenosis of the aortic valve can negatively impact the patient resulting in fatigue, shortness of breath and poor exercise tolerance. [3mhisinsideangle.com]

  This condition can keep blood from flowing properly throughout your body, which can lead to symptoms such as shortness of breath, fatigue, dizziness or lightheadedness, fainting, and chest pain. [beaumont.org]

  If your heart isn't working efficiently, you may feel aortic regurgitation symptoms including fatigue and short of breath. Aortic regurgitation can develop suddenly or over decades. It has a variety of causes, such as rheumatic fever or infection. [heart-valve-surgery.com]

• Congestive Heart Failure

  (congestive) heart failure I5023Acute on chronic systolic (congestive) heart failure I5030Unspecified diastolic (congestive) heart failure I5031Acute diastolic (congestive) heart failure I5032Chronic diastolic (congestive) heart failure I5033Acute on [cms.gov]

  UW Health Heart, Vascular and Thoracic doctors treat aortic valve insufficiency, which can increase the workload for the left ventricle of the heart and lead to congestive heart failure. [uwhealth.org]

  The main one is congestive heart failure. Medicines may not be effective in treating tricuspid regurgitation. Diuretics, or water pills, can help relieve body swelling, or edema, that’s due to congestive heart failure. [webmd.com]

  Once they occur, the aortic regurgitation symptoms are mostly from congestive heart failure. Left heart failure results in symptoms related to low cardiac output. [healio.com]

• Weakness

  Level II: Regurgitation fraction 20—39 %, the left ventricle fills up completely but is weak after several heartbeats with the contrast medium. [lecturio.com]

  However symptoms may include Tiredness Weakness Shortness of breath, especially with exercise or when you lie down Lightheadedness or fainting Swollen ankles ( oedema ) Treatment If the backflow of blood is mild then you may not need any treatment. [patient.info]

• Surgical Procedure

  Etiology and Surgical Procedure Surgical procedure Isolated Bicuspid Valve Repair (n=30) Bicuspid Valve Repair Associated With Aneurysm of the Ascending Aorta (n=38) AR indicates aortic regurgitation; STJ, sinotubular junction. [ahajournals.org]

  Procedural success ranged from 74% to 100%, and all-cause mortality was 7% at 30 days (range 0%-30%). [acc.org]

  procedures to prevent infection If the condition is rapidly declining, surgery is needed. [winchesterhospital.org]

  Surgical procedures include aortic valve repair and aortic valve replacement. I highly encourage you to visit your doctor or cardiologist if you are experiencing any of aortic regurgitation symptoms identified above. [heart-valve-surgery.com]

• Chest Discomfort

  A 58-year-old man who underwent AVR with mechanical valve due to severe aortic regurgitation secondary to BAV 7 years previously presented with exertional chest discomfort for 1 year. [ncbi.nlm.nih.gov]

  discomfort Shortness of breath Lightheadedness Dizziness Fainting Visit our Aortic Stenosis page to learn more. [umcvc.org]

  He presented to the local clinic with increasing of shortness of breath on exertion in the last 6 months and occasionally chest discomfort. Past medical history was unremarkable. [clinicsinsurgery.com]

• Dyspnea

  As the disease progresses, orthopnea and paroxysmal nocturnal dyspnea start to occur. Angina is predominantly nocturnal in these patients. [symptoma.com]

  Chronic AR is typically asymptomatic for years followed by progressive exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. [merckmanuals.com]

  Syncope, dyspnea, or arrhythmia, as well as angina pectoris and a sudden death, can be the symptoms, but compared to the aortic stenosis, this occurs only rarely. [lecturio.com]

  When the legs are elevated at night, the fluid redistributes centrally, causing pulmonary edema that results in orthopnea (dyspnea while lying flat) or paroxysmal nocturnal dyspnea. [healio.com]

• Orthopnea

  Chronic AR is typically asymptomatic for years followed by progressive exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. [merckmanuals.com]

  As the disease progresses, orthopnea and paroxysmal nocturnal dyspnea start to occur. Angina is predominantly nocturnal in these patients. [symptoma.com]

  Signs of acute left heart failure — including severe dyspnea, even at rest, orthopnea and PND — arise. Hypotension, flash pulmonary edema and shock can also occur. [healio.com]

• Exertional Dyspnea

  Chronic AR is typically asymptomatic for years followed by progressive exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. [merckmanuals.com]

  […] the ascending aorta Catheter balloon valvuloplasty Trauma Chronic : Etiology Rheumatic fever Marfan's syndrome Hypertension Bicuspid aortic valve Membranous ventricular septal defect Ascending aortic aneurysm Aortic valve prolapse Signs and Symptoms Exertional [echocardiology.org]

  Case presentation Case 1 A 58-year-old Chinese man was admitted to our department with chief complaint of exertional dyspnea for one month. His past medical history was unremarkable. [cardiothoracicsurgery.biomedcentral.com]

  Hence, in some patients determined to have only moderate MS at rest, the physiologic effects of heart rate sensitivity and atrioventricular compliance can produce exercise-induced pulmonary hypertension and exertional dyspnea. [content.onlinejacc.org]

• Regurgitation

  Level I: Regurgitation fraction < 20 %, very little contrast medium enters the left ventricle; it is completely excreted during systole. [lecturio.com]

  Pathophysiology of Chronic Aortic Regurgitation The diagnosis of aortic regurgitation can be made using a stethoscope. Its severity is reflected by the peripheral signs of aortic regurgitation. [aafp.org]

  This means that some of the blood that was already ejected from the heart is regurgitating back into the heart. The percentage of blood that regurgitates back through the aortic valve due to AI is known as the regurgitant fraction. [en.wikipedia.org]

• Abdominal Pain

  Hepatic congestion can also occur, producing right upper quadrant abdominal pain. Palpitations may result from the large stroke volumes and forceful LV contractions. [healio.com]

• Nausea

  Unfortunately, Zofran is usually prescribed for nausea and vomiting during the first trimester as that is when morning sickness generally reaches its highest peak. [zofranlawsuitguide.com]

  Postcatheterization complications include hemorrhage, vascular disruption after balloon dilation, pain, nausea, and vomiting. Other possible complications include arterial or venous obstruction by a thrombus or transient vasospasm. [emedicine.medscape.com]

• Vomiting

  Unfortunately, Zofran is usually prescribed for nausea and vomiting during the first trimester as that is when morning sickness generally reaches its highest peak. [zofranlawsuitguide.com]

  Postcatheterization complications include hemorrhage, vascular disruption after balloon dilation, pain, nausea, and vomiting. Other possible complications include arterial or venous obstruction by a thrombus or transient vasospasm. [emedicine.medscape.com]

• Pulsatile Liver

  liver) Gerhardt's sign (enlarged spleen) Duroziez's sign (systolic and diastolic murmurs heard over the femoral artery when it is gradually compressed) Hill's sign (A ≥ 20 mmHg difference in popliteal and brachial systolic cuff pressures, seen in chronic [doctorslounge.com]

• Heart Disease

  Aortic valve insufficiency can be due to, or associated with, congenital heart disease. [emedicine.medscape.com]

  I1311Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease I132Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or [cms.gov]

• Hypertension

  It is accompanied by systolic hypertension and wide pulse pressure, which account for peripheral physical findings, such as bounding pulses. [ncbi.nlm.nih.gov]

  Primary pulmonary hypertension and fenfluramine use. Br Heart J 1993 ;70: 537 - 541 4. McMurray J, Bloomfield P, Miller HC. Irreversible pulmonary hypertension after treatment with fenfluramine. BMJ 1986 ;292: 239 - 240 5. Heuer L. [content.nejm.org]

  Occasionally aortic insufficiency may be a result of bacterial endocarditis, dilatation of the aortic valve ring, hypertension and aortic arteriosclerosis, dissecting aortic aneurysm or trauma. [annals.org]

  Moderate or severe tricuspid regurgitation may result from pulmonary hypertension. Pulmonary hypertension is high blood pressure in the pulmonary artery. This high blood pressure has many possible causes. The main one is congestive heart failure. [webmd.com]

• Chest Pain

  Chronic aortic insufficiency leads to palpitations and dyspnea which is initially exertional and afterward occurs with minimal efforts and chest pain if coronary perfusion is compromised. [symptoma.com]

  Progressive expansion of the aneurysm may result in both aortic dissection or rupture with fatal hemorrhage and increasing aortic valvular regurgitation.1 Effective surgical therapy would relieve cardiac failure and chest pain due to valvular incompetence [jamanetwork.com]

  Symptoms may include chest pain or pressure, fainting, and shortness of breath. These are signs that you are likely to need surgery. [northshore.org]

  Symptoms may include Shortness of breath Chest pain that gets worse with exercise and goes away with rest Swelling in the ankles Fatigue Fast or fluttering pulse Severe cases can lead to heart failure. [texasheart.org]

• Palpitations

  First signs are palpitations. With the progression of the disease, reduced performance and signs of left ventricular failure become apparent. [lecturio.com]

  Symptoms can include fatigue, fainting, shortness of breath, palpitations (sensation of the heart beating), and swelling of the feet, legs, or abdomen. [uabmedicine.org]

  Chronic aortic insufficiency leads to palpitations and dyspnea which is initially exertional and afterward occurs with minimal efforts and chest pain if coronary perfusion is compromised. [symptoma.com]

  People with more severe aortic regurgitation may notice heart palpitations, chest pain, fatigue, or shortness of breath. Other symptoms include difficulty breathing when lying down, weakness, fainting, or swollen ankles and feet. [heart.org]

• Heart Murmur

  The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. But many people have heart murmurs without having a problem. [icdlist.com]

  At CHOP's Cardiac Center, we usually diagnose aortic regurgitation after a primary care doctor detects a heart murmur and refers a child to us. [chop.edu]

  Mild aortic regurgitation causes no symptom other than a characteristic heart murmur that can be heard with a stethoscope each time the left ventricle relaxes. People with severe regurgitation may develop symptoms when heart failure results. [msdmanuals.com]

  This video on aortic insufficiency (regurgitation) is part of a series on heart murmurs and valves called "Heart Valves Explained Clearly." [youtube.com]

• Confusion

  Auscultation signs can be confusing, because it is difficult to distinguish diastole from systole. This is because the heart sounds are soft or absent, and diastole becomes shorter than systole. [circ.ahajournals.org]

  Symptoms include severe shortness of breath, a rapid heart rate, lightheadedness, weakness, confusion, and chest pain. Acute aortic valve regurgitation is a medical emergency. Call 911 immediately. [northshore.org]

  […] repair combined techniques Table 1 AV repair combined techniques Table 2 AV repair using leaflet extension with pericardium Table 2 AV repair using leaflet extension with pericardium 2.1 Surgical anatomy and the mechanisms of insufficiency One source of confusion [academic.oup.com]

  Rarely, acute mitral regurgitation may direct regurgitant flow preferentially to a single pulmonary vein, with edema seen most prominently in that lung segment. 16 This finding is easily confused with pneumonia, particularly if the patient has endocarditis [doi.org]

• Giddiness

  Than he may complains of giddiness or faintness at times or of headache,or faintness at times or of headache, palpitations and dyspnoea on exertion.palpitations and dyspnoea on exertion. 12. [slideshare.net]

Blood workup in aortic valve insufficiency should include complete blood count, inflammatory markers, and cultures if endocarditis is suspected, coagulation parameters like prothrombin time and activated partial thromboplastin time, electrolyte panel, renal and hepatic tests and lactate dehydrogenase.

Echocardiography is a valuable and accurate tool in aortic insufficiency, allowing morphological valvular description, vegetation identification, and ascending aorta evaluation for dissection or aneurysm. Cavity dimensions and ejection fraction should be evaluated, especially if surgical intervention is needed [3].

Severe aortic valvular insufficiency is defined by certain parameters, derived from color, continuous and pulsed wave Doppler studies: vena contracta > 6 mm, regurgitant volume > 60 mL/beat, regurgitation fraction > 50%, and holodiastolic flow reversal in the descending aorta. Left ventricle dilation and ejection fraction should also be investigated, as well as pulmonary hypertension, pericardial effusion and aortic dissection [4]. Transesophageal echocardiography is especially useful in patients with poor acoustic windows or valvular calcification which makes it difficult to identify valve anatomy. An enlarged aorta may need additional characterization using computer tomography [5] or magnetic resonance imaging [6], while radionuclide imaging may be useful in further investigating left ventricular ejection fraction if echocardiography results are disproportional to clinical status.

Electrocardiography can show cavity enlargement or hypertrophy or ischemia, while chest radiography shows cardiac dilatation with valvular insufficiency is chronic and a cardiac normal size if the problem is acute in character. In addition, X-ray helps to detect pulmonary edema.

Exercise testing is indicated in order to assess functional capacity of the heart in chronic aortic regurgitation [7].

Aortic angiography is indicated if dissection is suspected while coronary angiography is performed in all patients scheduled to undergo aortic valvular replacement, in order to assess the need for a concomitant coronary bypass [8].

• Left Axis Deviation

  deviation（英语：Right axis deviation） Left axis deviation（英语：Left axis deviation） QT（英语：QT interval） Short QT syndrome（英语：Short QT syndrome） T T wave alternans（英语：T wave alternans） ST Osborn wave（英语：Osborn wave） ST elevation（英语：ST elevation） ST depression [zh.wikipedia.org]

• Left Ventricular Hypertrophy

  Therefore, a chronic aortic valve insufficiency causes an isolated left ventricular hypertrophy. Initially, the cardiac output can be maintained and the patients remain asymptomatic. [lecturio.com]

  ECG typically indicates left ventricular hypertrophy. [en.wikipedia.org]

  The pressure overload (due to elevated pulse pressure and the systemic effects of neuroendocrine hormones) causes left ventricular hypertrophy (LVH). There is both concentric hypertrophy and eccentric hypertrophy in AI. [cancertherapyadvisor.com]

  In ICD-10-CM, the code for left ventricular hypertrophy is I51.7 Cardiomegaly. The heart is divided into right and left sides by a septum (a muscular wall). [aapc.com]

  […] as a low-pitched mid-diastolic rumble at the apex Bisferien's pulse (widely notched arterial pulse, sometimes palpable) Electrocardiogram Left ventricular hypertrophy Left atrial enlargement Chest X-ray Cardiomegaly (cor bovinum) Dilated aortic root [echocardiology.org]

The outcome is generally poor if there is no treatment but is good with available modern treatments. [patient.info]

Treatment of Aortic Insufficiency Medical Treatment Involves: 1- Vasodilators to decrease afterload à ACEIs or ARBs / Nifedipine 2- Decrease the pulmonary congestion with diuretics or digitalis. [lecturio.com]

Although primarily intended for the treatment of severe AS, it has the potential to develop a role in the treatment of aortic regurgitation, given its unique technical design. [icrjournal.com]

Analysis of determinants of survival with conservative treatment is essential to define high-risk groups that require aggressive treatment. [doi.org]

The outlook (prognosis) is good if the valve is treated before the heart becomes badly damaged. What is the outcome? The outcome (prognosis) will depend on the underlying cause and the severity of aortic regurgitation. [patient.info]

Despite surgical therapy, patients with anuloaortic ectasia have a worse prognosis than those with aortic valve insufficiency. [ncbi.nlm.nih.gov]

Insufficiency A frequent cause of aortic valve insufficiency is bacterial endocarditis but even congenital diseases or congenital defects can cause this disorder, which can remain asymptomatic in its chronic course and have, in this case, a favorable prognosis [lecturio.com]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

Regarding etiology, structural abnormalities, such as a bicuspid aortic valve or prolapse of the AV may be seen. [healio.com]

Treatment and prognosis The decision to treat aortic regurgitation is based on the etiology and severity. [radiopaedia.org]

Etiology of Aortic Insufficiency Image : „Phonocardiograms from Normal and Abnormal Heart Sounds” by Madhero88. [lecturio.com]

[…] in the literature in association with AR or aortic valve endocarditis. [18] Connective tissue disorders that can cause significant AR include the following: Floppy aortic valve Aortic valve prolapse Sinus of Valsalva aneurysm Aortic annular fistula Epidemiology [emedicine.medscape.com]

Pathophysiology of Aortic Insufficiency Changes due to aortic insufficiency Due to the constant backflow of blood into the left ventricle, the volume load rises. [lecturio.com]

View this table: In this window In a new window Table 1 Aetiology of aortic regurgitation (AR) PATHOPHYSIOLOGY AND HAEMODYNAMIC CONSIDERATIONS AR causes volume overload of the left ventricle (LV). [doi.org]

Includes discussion on the causes, pathophysiology, clinical features and murmur, diagnosis, treatment, and indications for valve replacement. [youtube.com]

Pathophysiologically, the left ventricle must continue to eject a large stroke volume to keep forward stroke volume normal. [aafp.org]

Prevention Aortic insufficiency may not be preventable. If you have a family history, talk with your doctor about screening tests. [winchesterhospital.org]

Based on this analysis the preventive competence of some drugs with remodelling potential is postulated: vasodilators, growth hormone, thyroxin analogues and carnitinepalmitoyltransferase-1 inhibitors. (Ref. 36.). [ncbi.nlm.nih.gov]

Prevention and Self-care One possible way to prevent aortic valve regurgitation is to prevent rheumatic fever. Untreated strep throat can develop into rheumatic fever. Fortunately, strep throat is easily treated with antibiotics. [doctorslounge.com]

Make sure it's well-controlled to prevent aortic regurgitation. Aug. 02, 2017 [mayoclinic.org]

After each heartbeat, the valve closes tightly to prevent blood from flowing backwards into the heart. Aortic insufficiency occurs when the aortic valve does not close tightly enough. [health.cvs.com]

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2. Dujardin KS, Enriquez-Sarano M, Schaff HV, et al. Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study. Circulation 1999;99:1851 – 1857.
3. Friedman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther. 2008;6(2):235-248.
4. Lancellotti P, Tribouilloy C, Hagendorff A, et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr. 2010;11(3):223-244.
5. Gaztanaga J, Pizarro G, Sanz J. Evaluation of cardiac valves using multidetector CT. Cardiol Clin. 2009;27(4):633-644.
6. Morello A, Gelfand EV. Cardiovascular magnetic resonance imaging for valvular heart disease. Curr Heart Fail Rep. 2009;6(3):160-166
7. Picano E, Pibarot P, Lancellotti P. The emerging role of exercise testing and stress echocardiography in valvular heart disease. J Am Coll Cardiol. 2009;54(24):2251-2260.
8. [Guideline] Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129 (23):e521-643.