Aortic Regurgitation Treatment in Delhi, India

Aortic regurgitation, also known as aortic insufficiency, is a heart valve disease. It occurs when the aortic valve, located between the left ventricle (the heart's main pumping chamber) and the aorta (the body's main artery), fails to close completely. This malfunction allows some blood to leak back into the left ventricle during the heart's relaxation phase (diastole) instead of flowing forward to the body. As a consequence, the left ventricle has to work harder to pump enough blood throughout the body, which can lead to various complications over time.

The causes and risk factors of aortic regurgitation often overlap, as both influence the development and progression of this heart valve disorder. Here's a comprehensive list combining both causes and risk factors:

• Congenital Heart Defects: Individuals born with abnormalities in the structure of the aortic valve, such as a bicuspid aortic valve (two leaflets instead of the usual three), are predisposed to aortic regurgitation.
• Degenerative Changes: Wear and tear on the aortic valve over time, particularly in older adults, can lead to degenerative changes, causing thickening or calcification of the valve, impairing its function.
• Rheumatic Fever: Untreated streptococcal infection can lead to rheumatic fever, causing inflammation and damage to the heart valves, including the aortic valve.
• Endocarditis: Infective endocarditis, an infection of the inner lining of the heart, can lead to damage and subsequent regurgitation of blood through the aortic valve.
• Aortic Root Dilatation: Enlargement of the aortic root due to conditions such as Marfan syndrome, connective tissue disorders, hypertension, or atherosclerosis can stretch the valve leaflets and prevent proper closure, resulting in regurgitation.
• Trauma: Blunt chest trauma or aortic dissection (a tear in the inner layer of the aorta) can damage the aortic valve, leading to regurgitation.
• Other Valve Disorders: Conditions affecting other heart valves, such as aortic stenosis (narrowing of the aortic valve), can cause changes in blood flow and pressure, contributing to aortic regurgitation.
• Age: The risk of developing aortic regurgitation increases with age, particularly in individuals over 65.
• High Blood Pressure: Chronic hypertension can contribute to the development and progression of aortic regurgitation.
• Family History: A family history of heart valve disorders or connective tissue disorders may increase the risk of aortic regurgitation.
• Connective Tissue Disorders: Conditions such as Marfan syndrome or Ehlers-Danlos syndrome increase the risk of aortic regurgitation due to their effects on the aorta and heart valves.

Aortic regurgitation can manifest a range of symptoms that may vary depending on the severity of the condition. Common symptoms of aortic regurgitation include:

• Shortness of Breath: Especially during physical exertion or when lying flat, due to the decreased efficiency of blood circulation.
• Fatigue and Weakness: Resulting from reduced oxygen delivery to tissues and organs due to inefficient blood flow.
• Chest Pain or Discomfort: Particularly with exertion, although this symptom may not be present in all cases.
• Heart Palpitations: An awareness of irregular or forceful heartbeats, often due to changes in heart rhythm associated with aortic regurgitation.
• Swelling (Edema): Especially in the ankles and feet, caused by fluid retention as a result of heart failure, a complication of severe aortic regurgitation.
• Dizziness or Fainting: Due to reduced blood flow to the brain, particularly when changing positions or exerting oneself.
• Heart Murmur: A healthcare provider may detect an abnormal heart sound called a murmur during a physical examination.
• Pulsations in the Neck: Prominent pulsations in the neck arteries (carotid arteries) may be visible or palpable due to the increased volume of blood ejected from the heart during each heartbeat.

It's important to note that some individuals with mild or moderate aortic regurgitation may not experience noticeable symptoms for many years. However, as the condition progresses, symptoms are more likely to develop. If an individual experiences any of these symptoms or has concerns about their heart health, it's essential to consult with a healthcare professional for proper evaluation and management.

Diagnosing aortic regurgitation typically involves a combination of medical history review, physical examination, and various diagnostic tests. Here's an overview of the diagnostic process:

• Medical History and Physical Examination: A healthcare provider will begin by gathering information about the patient's symptoms, medical history, and any risk factors for heart disease. During the physical examination, the healthcare provider may listen for abnormal heart sounds, such as a murmur, and assess for signs of heart failure, such as swelling in the extremities or abnormal pulsations in the neck.
• Echocardiography: Echocardiography is the primary imaging modality used to diagnose aortic regurgitation. This non-invasive test uses sound waves (ultrasound) to create images of the heart's structure and function. Echocardiography can evaluate the size and function of the heart chambers, assess the movement of the heart valves, and quantify the severity of regurgitation.
• Electrocardiogram (ECG or EKG): An ECG records the electrical activity of the heart and can help identify rhythm abnormalities, such as arrhythmias, which may be associated with aortic regurgitation.
• Chest X-ray: A chest X-ray may be performed to assess the size and shape of the heart and detect any signs of heart failure, such as fluid buildup in the lungs.
• Cardiac MRI or CT Scan: In some cases, cardiac magnetic resonance imaging (MRI) or computed tomography (CT) may be used to provide detailed images of the heart and aorta, which can help evaluate the structure and function of the heart valves and assess for any associated abnormalities.
• Exercise Stress Test: In patients with symptoms suggestive of aortic regurgitation, an exercise stress test may be performed to evaluate how the heart responds to physical activity and to assess for exercise-induced symptoms or changes in heart function.
• Transesophageal Echocardiography (TEE): In TEE, a specialised echocardiography probe is passed into the oesophagus to obtain high-quality images of the heart structures, including the aortic valve, from a closer vantage point. TEE may be used in cases where transthoracic echocardiography (TTE) does not provide clear images or to assess for complications such as infective endocarditis.

Once a diagnosis of aortic regurgitation is confirmed, further evaluation may be needed to assess the severity of the condition and determine the most appropriate treatment approach. Close monitoring and regular follow-up with a healthcare provider are essential for individuals diagnosed with aortic regurgitation.

Treatment for aortic regurgitation aims to manage symptoms, prevent complications, and address the underlying cause of the condition. The specific treatment approach depends on the severity of the regurgitation and individual patient factors. Here are the main treatment options:

Medications

• Blood pressure medications: Drugs such as ACE inhibitors, angiotensin II receptor blockers (ARBs), or diuretics may be prescribed to help lower blood pressure and reduce the workload on the heart.
• Vasodilators: Medications like nitrates can relax blood vessels and decrease the amount of blood that flows back into the heart.
• Beta-blockers or calcium channel blockers: These medications can help slow down the heart rate and reduce strain on the heart muscle.

Regular Monitoring

For mild cases of aortic regurgitation without symptoms or with mild symptoms, regular monitoring by a healthcare provider may be recommended. This typically involves periodic check-ups to assess the progression of the condition and monitor any changes in symptoms.

Surgical Intervention

• Valve repair: In some cases, particularly if the aortic valve damage is minimal, surgical repair of the valve may be possible. This involves reconstructing or repairing the valve to improve its function.
• Valve replacement: If the aortic valve is severely damaged and cannot be repaired, valve replacement surgery may be necessary. This procedure involves replacing the damaged valve with either a mechanical or biological valve. Mechanical valves are durable but require lifelong anticoagulation therapy to prevent blood clots, while biological valves do not require anticoagulation but may need to be replaced over time.

Lifestyle Modifications

• Regular exercise: Engaging in regular physical activity under the guidance of a healthcare provider can help improve cardiovascular health and overall well-being.
• Heart-healthy diet: Consuming a diet low in saturated fats, cholesterol, and sodium can help manage blood pressure and reduce strain on the heart.
• Smoking cessation: Quitting smoking is essential for individuals with aortic regurgitation, as smoking can exacerbate symptoms and increase the risk of complications.
• Limiting alcohol intake: Excessive alcohol consumption can worsen symptoms of aortic regurgitation and should be avoided or limited.

Individuals with aortic regurgitation should work closely with their healthcare provider to develop a personalised treatment plan based on their specific needs and the severity of their condition. Early detection and appropriate management can help improve outcomes and quality of life for individuals with aortic regurgitation.

Aortic regurgitation, if left untreated or poorly managed, can lead to various complications due to the increased workload on the heart and alterations in blood flow. Some common complications associated with aortic regurgitation include:

• Heart Failure: Over time, the increased volume of blood flowing back into the left ventricle can lead to an enlarged and weakened heart muscle, resulting in heart failure.
• Arrhythmias: Aortic regurgitation can disrupt the heart's electrical activity, leading to abnormal heart rhythms or arrhythmias, which may cause palpitations, dizziness, fainting, or chest discomfort.
• Endocarditis: Individuals with aortic regurgitation are at increased risk of infective endocarditis, an infection of the inner lining of the heart chambers and valves, which can be serious if left untreated.
• Aortic Aneurysm or Dissection: Chronic pressure overload on the aortic root can weaken the walls of the aorta, leading to the formation of aneurysms or dissections, which are potentially life-threatening complications requiring prompt medical attention.
• Stroke: Severe aortic regurgitation increases the risk of blood clots forming within the heart, which can travel to the brain and cause a stroke or transient ischemic attack (TIA).
• Sudden Cardiac Death: In rare cases, severe aortic regurgitation can lead to sudden cardiac death, particularly if the condition is not promptly diagnosed and treated.
• Decreased Exercise Tolerance: As the condition progresses, individuals may experience fatigue, shortness of breath, and reduced exercise tolerance due to the heart's decreased ability to pump blood effectively.
• Reduced Quality of Life: Symptoms such as fatigue, shortness of breath, and chest discomfort can significantly impact an individual's quality of life, affecting their ability to perform daily activities and engage in physical exercise.

Preventing aortic regurgitation primarily involves addressing risk factors and promoting heart-healthy behaviours. While some causes of aortic regurgitation, such as congenital heart defects, may not be preventable, the following measures can help reduce the risk of developing or worsening the condition:

• Go for Regular Check-ups: Schedule routine visits to healthcare providers to monitor and manage conditions contributing to aortic regurgitation.
• Control Blood Pressure: Adopt lifestyle changes and medications to manage hypertension, a key risk factor for aortic regurgitation.
• Prevent Infective Endocarditis: Maintain good oral hygiene and undergo dental procedures as recommended to lower the risk of heart infections.
• Quit Smoking: Avoid smoking and exposure to secondhand smoke to reduce the risk of aortic regurgitation progression.
• Maintain Healthy Weight: Follow a balanced diet and exercise regularly to manage weight and lower the risk of cardiovascular conditions.
• Moderate Alcohol Intake: Limit alcohol consumption to reduce the risk of high blood pressure and heart muscle damage.
• Manage Cholesterol: Eat a heart-healthy diet and take prescribed medications to control cholesterol levels and prevent atherosclerosis.
• Exercise Regularly: Incorporate physical activity into daily routines to maintain cardiovascular health and lower the risk of hypertension and atherosclerosis.
• Stress Management: Practise stress-reducing techniques such as relaxation exercises to promote heart health and lower blood pressure.

These strategies, when followed consistently, can help reduce the likelihood of developing or exacerbating aortic regurgitation and other cardiovascular conditions.

What is the life expectancy of a person with aortic valve regurgitation?

The life expectancy of a person with aortic regurgitation can vary widely depending on factors such as the severity of the condition, the presence of symptoms, and the effectiveness of treatment. With appropriate management, many individuals with aortic regurgitation can live long and fulfilling lives.

What foods should be avoided with aortic regurgitation?

While there are no specific foods that must be avoided solely because of aortic regurgitation, individuals with this condition should generally follow a heart-healthy diet low in saturated fats, cholesterol, and sodium. Avoiding excessive alcohol intake and caffeine may also be beneficial.

Is aortic regurgitation a medical emergency?

In most cases, aortic regurgitation is not considered a medical emergency. However, if individuals experience severe symptoms such as chest pain, severe shortness of breath, fainting, or palpitations, they should seek immediate medical attention as these may indicate a complication or acute worsening of the condition.

Who treats aortic regurgitation?

Aortic regurgitation is typically managed by a team of healthcare providers, including cardiologists, cardiac surgeons, and other specialists such as echocardiographers and nurses. The specific treatment approach depends on the severity of the condition and individual patient factors.

What is the outlook/prognosis for individuals with aortic regurgitation?

The outlook for individuals with aortic regurgitation depends on various factors, including the severity of the condition, the presence of symptoms, and the effectiveness of treatment. With appropriate management, including regular monitoring and, if necessary, surgical intervention, many individuals can lead active and healthy lives. However, severe aortic regurgitation or complications such as heart failure may impact long-term prognosis. Regular follow-up with healthcare providers is essential for optimising outcomes.

How often should I have follow-up appointments with my healthcare provider if I have aortic regurgitation?

Follow-up appointments frequency depends on the severity of your condition. Typically, regular monitoring is necessary to assess the progression of aortic regurgitation and determine if any treatment adjustments are needed.

Can aortic regurgitation be managed with medication alone, or will I eventually need surgery?

The management approach varies based on the severity of aortic regurgitation. While medications can help manage symptoms, surgery may be necessary for severe cases or if symptoms worsen over time.

What precautions should I take before undergoing dental procedures or surgeries due to my increased risk of infective endocarditis?

It's important to inform your dentist or surgeon about your condition to receive appropriate antibiotic prophylaxis to reduce the risk of infective endocarditis. Always follow your healthcare provider's recommendations.

Is it safe for me to engage in physical activities or exercise with aortic regurgitation?

In general, moderate physical activity is safe and beneficial for individuals with aortic regurgitation. However, it's essential to discuss exercise plans with your healthcare provider, who can provide personalised recommendations based on your condition's severity and overall health.

What symptoms should I watch out for that may indicate my condition is worsening, and when should I seek medical attention?

Symptoms such as increasing fatigue, shortness of breath, chest pain, or palpitations may indicate worsening aortic regurgitation. If you experience these symptoms or notice any significant changes in your condition, seek medical attention promptly.

Are there any genetic factors or hereditary conditions that increase the risk of developing aortic regurgitation?

Some genetic conditions, such as Marfan syndrome or bicuspid aortic valve, may increase the risk of aortic regurgitation. It's essential to discuss your family history with your healthcare provider to assess your risk and consider appropriate screening.

Can aortic regurgitation affect pregnancy or childbirth?

Pregnancy may increase the workload on the heart and worsen symptoms in women with severe aortic regurgitation. It's crucial to discuss pregnancy plans with your healthcare provider to assess the risks and consider appropriate monitoring and management strategies.

What are the potential long-term effects of aortic regurgitation on my heart health and overall well-being?

Long-term effects may include heart failure, arrhythmias, and complications such as aortic aneurysm or dissection. Regular monitoring and appropriate management can help minimise these risks and promote overall well-being.

Reviewed by Dr. Dinesh Chandra, Principal Consultant, Cardiac Surgery (CTVS) on 8-May-2024.