Aortic regurgitation symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

Aortic insufficiency can cause many symptoms such as dyspnea, weakness and congestive heart failure. Chronic aortic insufficiency maybe without symptoms for several years until decreasing the stroke volume and cardiac output due to heart failure progression.

Acute Aortic Regurgitation

In acute severe aortic regurgitation (AR),there is a sudden decrease in stroke volume and increase in left ventricular end diastolic volume which manifests as:

• Sudden cardiovascular collapse (severe dyspnea , weakness)
• Secondary hypotension
• Rapidly developing left heart failure

Chronic Aortic Regurgitation

In Chronic AR, patients are usually asymptomatic for several 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 progressive decrease in stroke volume and cardiac output leading to left ventricular failure manifesting as:

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