May Be Asymptomatic but Serious

By Kelly Burch 

Updated on October 25, 2023

 Medically reviewed by Richard N. Fogoros, MD

Aortic valve regurgitation is a type of heart valve disease that occurs when your heart’s aortic valve doesn’t close tightly, causing blood to leak backward with each heartbeat. A leaky aortic valve, also called aortic insufficiency, makes it more difficult for your heart to pump blood to the rest of the body.

Many people have no symptoms at first, but as the condition worsens, they may experience chest pain, palpitations, and shortness of breath. Over time, a leaky aortic valve can damage the heart, even leading to congestive heart failure, so timely treatment is crucial. 

Continue reading to learn more about aortic valve regurgitation and heart valve leakage, including symptoms, diagnosis and treatment.

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What Happens in Aortic Regurgitation?

With aortic regurgitation, a small amount of blood leaks backwards from the aortic valve into the left ventricle.¹ This happens because the aortic valve, which allows blood to flow from the left ventricle into the aorta, doesn’t close tightly.²

To understand why this is significant, it’s helpful to learn about the anatomy of the heart. In a healthy heart, blood blows from the left ventricle, the largest and most powerful of the heart’s four chambers. The left ventricle pumps blood through the aortic valve into the aorta, the largest artery in the body. From there, blood flows throughout the body, delivering oxygen to your muscles and tissues. 

 Aortic Regurgitation

With aortic regurgitation, some of the blood that is ejected into the aorta. With each heartbeat, the blood leaks back into the left ventricle in between heartbeats.¹ This means the heart needs to work harder to pump enough blood to your body.

Over time, the wall of the left ventricle can get thicker, which makes it more difficult to pump. Eventually, your heart might not be able to pump enough blood to keep you healthy. This is a condition called congestive heart failure.³ 

How Does a Leaky Aortic Valve Affect the Body?

The heart has four valves that regulate blood flow among the four chambers of the heart. When the valves are working well, the cardiac cycle happens as it should, allowing your heart to pump blood efficiently throughout the body.

But when the valves are leaky, the heart cannot pump efficiently. It must work harder to meet your body’s need for oxygen. Over time, this extra effort can damage the heart and lead to heart disease and heart failure.⁴ 

Symptoms of Aortic Regurgitation

Most people with aortic regurgitation don’t have symptoms at first. People can be asymptomatic (have no symptoms) for many years. Then, symptoms can come on slowly or suddenly. The symptoms of aortic regurgitation include:²

• A pounding pulse

• Palpitations 

• Chest pain

• Fatigue

• Shortness of breath, especially with activity

As the condition worsens, you may notice:¹

• Shortness of breath while lying down

• Waking up short of breath

• Swelling in the ankles and feet

• Weakness, especially with activity

• Fainting or light-headedness

You may also experience complications including:²

• Abnormal heartbeat

• Heart failure

• Infection of the heart

Whom Does Aortic Regurgitation Affect?

This condition can impact anyone. About 5%–10% of Americans will have aortic regurgitation. An echocardiogram (an ultrasound of the heart) can even reveal the condition in otherwise healthy people. The condition is more common in men than women and is most often found in people over age 50.⁵

Causes and Risk Factors for Aortic Regurgitation

Aortic regurgitation is caused by weakening of the aortic valve. This can happen due to normal aging, or because of the following:²

• High blood pressure (hypertension)

• Rheumatic fever (more common in the past)

• Untreated syphilis

• Endocarditis, an infection of the heart valve

• Injury or trauma to the chest

• Reiter syndrome (reactive arthritis)

• Marfan syndrome

• Ankylosing spondylitis, a form of inflammatory arthritis 

• Systemic lupus erythematosus (SEL), the most common type of lupus

• Congenital valve problems (present at birth)

How Is Aortic Regurgitation Diagnosed?

Your healthcare provider will use an exam and image technology to diagnose aortic regurgitation. During the exam, they might look for signs of the condition, including:²

• A heart murmur

• Forceful heartbeat

• Bobbing the head in time with the heartbeat

• Hard pulses in the legs and arms

• Low diastolic blood pressure

• Symptoms of fluid on the lungs

In addition, they might order imaging tests to get a better idea of how blood is flowing through your heart. These can include:²

• Aortic angiography, which uses dyes and X-rays to see how blood flows through the aorta

• Echocardiogram, or ultrasound of the heart

• Magnetic resonance imaging (MRI) or computed tomography (CT) scan

• Chest X-ray

• Left heart catheterization

How Is Aortic Regurgitation Treated?

If you’re not having symptoms, your healthcare provider might recommend monitoring your condition with regular echocardiograms. However, medications are often needed.¹ These can include:²

• Blood pressure medication if you have high blood pressure

• Diuretics to ease the symptoms of heart failure

• Blood thinners to reduce the risk of clotting or stroke

If your medications don’t improve your heart health, your healthcare provider may recommend surgery called an aortic valve replacement. This is an open-heart surgery to replace the damaged valve.⁶

Interest is building for a minimally invasive version of this surgery that does not require opening the chest. This surgical repair procedure that implants a new valve by way of a catheter is expected to become more common with time, so talk with your healthcare provider about available options.²

Lifestyle Changes for Aortic Regurgitation

Your healthcare provider might recommend avoiding certain activities that make your symptoms worse. For example, if you experience symptoms while exercising, your healthcare provider might recommend modifications.²

If you have aortic regurgitation it can also be helpful to live a heart-healthy lifestyle, which includes:⁷

• Eating heart-healthy foods

• Exercising

• Avoiding tobacco, alcohol, and drugs

• Seeing your healthcare provider regularly and taking all medication they prescribe

Can You Prevent Aortic Regurgitation?

Some people are born with aortic valve problems that cannot be prevented. However, many others can reduce their risk of aortic regurgitation by focusing on cardiovascular health.⁷ Exercise, eat healthy, and get regular medical care. 

Reducing high blood pressure and maintaining healthy blood pressure is especially important for preventing aortic regurgitation.² Ask your healthcare provider about medications and lifestyle adjustments that can help you manage your blood pressure. 

Outlook for People With Aortic Regurgitation

With treatment and medical oversight, people with aortic regurgitation have a good prognosis, or outlook.² It’s very important to see a cardiologist (heart doctor) and keep in touch with them, even if you’re not experiencing symptoms. Regular monitoring can help you detect changes to your heart health early and avoid complications like congestive heart failure. 

Summary

Aortic regurgitation is a condition where the aortic valve doesn’t close tightly. This allows blood to flow backwards into the left ventricle of the heart, and makes it more difficult for the heart to provide oxygen to the whole body. Over time, if left untreated, aortic regurgitation can lead to heart damage and heart failure. However, with medication, lifestyle changes, and possibly surgery, people with aortic regurgitation can lead healthy lives.

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