Aortic Regurgitation (also known as Aortic Insufficiency) occurs when the heart’s aortic valve does not close tightly. This allows some of the blood that was just pumped out of the main pumping chamber (left ventricle) to leak backward into it.
In a healthy heart, the aortic valve acts as a one-way gate. In AR, this gate is “leaky.”
The Result: The left ventricle has to work much harder to pump the same amount of blood to the body.
The Long-Term Effect: Over time, the ventricle stretches (dilates) and thickens (hypertrophy), eventually leading to heart failure if left untreated.
Causes are generally split into problems with the valve leaflets themselves or the aortic root (the “frame” holding the valve).
Valvular Issues: Bicuspid aortic valve (a common birth defect), Infective Endocarditis (infection of the heart lining), and Rheumatic Heart Disease.
Aortic Root Issues: Aortic Aneurysm, Aortic Dissection, and Marfan Syndrome (a connective tissue disorder).
Secondary Factors: Chronic high blood pressure (Hypertension) and age-related “wear and tear” (calcification).
Aortic Regurgitation is often “silent” for years because the heart is very good at compensating. Symptoms usually appear once the heart begins to struggle:
Exertional Dyspnoea: Shortness of breath during physical activity.
Fatigue: Feeling unusually tired, even after rest.
Palpitations: A “bounding” heartbeat felt in the chest or neck.
Chest Pain (Angina): Occurs because the thickened heart muscle requires more oxygen than the coronary arteries can provide.
Advanced Signs: Waking up gasping for air (PND) or needing extra pillows to breathe at night (Orthopnoea).
A clinician will look for several classic physical signs during an examination:
The Murmur: A high-pitched, blowing diastolic murmur heard best when the patient sits forward and holds their breath in expiration.
Collapsing Pulse: Also known as a “Water-Hammer Pulse”—a forceful pulse that suddenly collapses.
Wide Pulse Pressure: A large gap between the top (systolic) and bottom (diastolic) blood pressure numbers (e.g., 170/50 mmHg).
Echocardiogram: The “Gold Standard.” It measures the size of the leak and the “ejection fraction” (how well the heart is pumping).
ECG: May show signs of an enlarged left ventricle (Left Ventricular Hypertrophy).
Cardiac MRI: In 2026, MRI is increasingly used if echocardiogram results are unclear, providing precise measurements of the regurgitant volume.
Chest X-ray: To check for an enlarged heart shadow (cardiomegaly) or fluid in the lungs.
Management is dictated by whether the patient has symptoms and the degree of heart “stretching.”
Mild to Moderate AR: “Watchful Waiting.” Regular follow-ups (usually every 6–12 months) in a dedicated Heart Valve Clinic.
Medical Therapy: Drugs like ACE Inhibitors or Calcium Channel Blockers (Nifedipine) are used to manage blood pressure and reduce the workload on the valve.
Surgical Intervention: This is the only definitive cure for severe AR.
Aortic Valve Replacement (AVR): Replacing the valve with a mechanical or biological (tissue) valve.
Aortic Root Repair: If the leak is caused by a dilated aorta rather than the valve itself.
If left untreated, severe Aortic Regurgitation can lead to:
Irreversible Heart Failure: Where the heart muscle becomes too weak to recover even after surgery.
Arrhythmias: Such as Atrial Fibrillation.
Infective Endocarditis: A leaky valve is more prone to life-threatening infections.
Asymptomatic: Patients can live for decades with mild AR without needing surgery.
Symptomatic: Once symptoms of heart failure appear, the prognosis drops significantly without surgery. Modern valve replacements now have excellent 10- and 20-year survival rates.
Blood Pressure Control: The most important factor in slowing the progression of AR.
Dental Hygiene: Essential to prevent bacteria from the mouth entering the bloodstream and infecting the heart valve (Endocarditis).
Prompt Treatment of Strep Throat: To prevent Rheumatic Fever, especially in younger populations.
Current 2026 guidelines recommend referral if:
The regurgitation is graded as Moderate or Severe on an echo.
The patient develops any new shortness of breath or chest pain.
The Aortic Root is found to be wider than 45mm.
There is evidence that the Left Ventricle is starting to enlarge or weaken.
| Severity | Monitoring Frequency | Primary Action |
| Mild | Every 2–3 years | Blood pressure control |
| Moderate | Every 6–12 months | Monitor for symptom onset |
| Severe (No Symptoms) | Every 3–6 months | Assess for surgery “triggers” |
| Severe (Symptomatic) | Immediate | Surgical Valve Replacement |
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