Aortic regurgitation symptoms

Aortic Regurgitation Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

The symptoms of acute aortic regurgitation (AR) include dyspnea, chest pain (if aortic dissection is the cause of AR), weakness, and symptoms of congestive heart failure. Chronic AR may be asymptomatic for several years until there is a decrease in the stroke volume and cardiac output due to heart failure progression. Symptoms of chronic AR include exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and palpitations.

History and Symptoms

Acute Aortic Regurgitation

In acute severe AR, there is a sudden decrease in the stroke volume and increase in left ventricular end diastolic volume and left ventricular end diastolic pressure which manifests as either sudden and severe dyspnea and/or chest pain (if aortic dissection is the cause of AR). Based on the history and symptoms, the cause of the acute symptoms can be suspected.

Type A Aortic Dissection

• Chest pain of the following characteristics:
  • Sudden onset
  • Intense
  • Tearing and sharp
  • Worse with deep breath or cough
  • Relieved by sitting upright
• Unexplained syncope
• Previous history of:
  • Hypertension
  • Marfan syndrome
  • Connective tissue disorder

Infective Endocarditis

• Persistent fever
• Positive previous blood culture
• High risk factors:
  • Pre-existing cardiac abnormality
  • Prosthetic valve
  • Recent surgical or medical procedures
  • Intravenous drug use
  • Recent bacterial infection
• History of previous endocarditis

Symptomatic Severe Chronic Aortic Regurgitation

• Previous history of aortic valve disease

Chronic Aortic Regurgitation

In chronic aortic regurgitation (AR), patients are usually asymptomatic for many years as the stroke volume is maintained by increased force of left ventricular contraction secondary to increased left ventricular preload as explained by Frank-Starling mechanism.

With progression of AR, the compensatory mechanisms begin to fail causing gradual enlargement of the left ventricle, thereby progressively increasing left ventricular end diastolic pressure, decreasing stroke volume and cardiac output leading to left ventricular failure manifesting as:

• Dyspnea on exertion
• Orthopnea
• Paroxysmal nocturnal dyspnea
• Palpitations (due to compensatory tachycardia)
• Chest pain (if left ventricular end diastolic pressure compromises coronary perfusion)

Once symptoms arise, cardiac function usually worsens more rapidly and mortality may exceed 10% per year.

Pertinent Elements in the Past Medical History

• Cardiac disease:
  • Hypertension
  • Bicuspid aortic valve
• Rheumatic fever
• Pulmonary disease
• Trauma
• Syphilis
• Ankylosing spondylitis
• Acromegaly
• Marfan syndrome
• Ehlers-Danlos syndrome
• Giant cell arteritis
• Takayasu's arteritis
• Previous cardiac surgery