Aortic regurgitation symptoms

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Aortic insufficiency
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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.; Rim Halaby, M.D. [3]; Usama Talib, BSc, MD [4]


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.[1][2]

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.[3][4][5][6]

Type A Aortic Dissection

The following findings may indicate presence of Aortic Dissection in a person with Aortic Regurgitation.[2][7][8][9]

Infective Endocarditis

The following factors can be present in a person with Infective Endocarditis and aortic regurgitation.[3][10][11]

  • Persistent fever
  • Previous positive 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 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 the progression of AR, the compensatory mechanisms begin to fail causing gradual enlargement of the left ventricle, thereby progressively increasing the left ventricular end diastolic pressure as well as decreasing the stroke volume and the cardiac output leading to left ventricular failure that manifest as: [1][12][13]

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

Pertinent Elements in the Past Medical History

The following are some important elements in the past medical history of a patient with suspected aortic regurgitation.


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  2. 2.0 2.1 Icli A, Mutlu H, Karabag T, Kahraman H (2015). "Decreased coronary blood flow velocity in patients with aortic insufficiency but normal coronary arteries: the use of TIMI frame count in aortic insufficiency cases". Int J Clin Exp Med. 8 (9): 16358–63. PMC 4659045. PMID 26629157.
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