What Is Aortic Regurgitation?

Written By Aram Kerr

Aortic regurgitation (AR) is a condition in which the aortic valve does not close tightly. When this happens, some blood leaks backward into the heart instead of continuing forward to the body with each heartbeat.

The aortic valve sits between the left ventricle (the heart’s main pumping chamber) and the aorta, the largest artery in the body. Normally, the valve opens when the heart contracts to send blood out and then closes completely when the heart relaxes. In aortic regurgitation, that closure is incomplete, allowing blood to flow backward into the left ventricle.

This backflow increases the heart’s workload over time and can eventually lead to heart enlargement, reduced pumping efficiency, and symptoms.

Why Aortic Regurgitation Is Concerning

When blood leaks backward through the aortic valve:

  • The left ventricle fills with extra blood (volume overload)

  • The heart stretches and thickens to compensate

  • Pumping becomes less efficient over time

Early on, the heart may adapt well and symptoms may be absent. As regurgitation worsens, however, the risk of heart failure, rhythm disturbances, and reduced exercise tolerance increases.

Types of Aortic Regurgitation

Chronic Aortic Regurgitation

  • Develops gradually over years

  • Most common form in the U.S.

  • Often asymptomatic in early stages

Acute Aortic Regurgitation

  • Develops suddenly

  • A medical emergency

  • Can rapidly cause shortness of breath, pulmonary edema, and low cardiac output

Healthcare providers may also classify AR by severity and stage, which helps guide monitoring and treatment decisions.

Symptoms of Aortic Regurgitation

Mild or early AR may cause no symptoms. As the condition progresses, symptoms may include:

  • Shortness of breath with activity or when lying flat

  • Fatigue or reduced stamina

  • Chest pain or pressure

  • Heart palpitations

  • Lightheadedness or fainting

  • Swelling in the ankles or feet

Symptoms usually appear after the heart has already undergone structural changes, making early detection especially important.

What Causes Aortic Regurgitation?

Common causes include:

  • Age-related valve degeneration

  • Congenital valve abnormalities, such as a bicuspid aortic valve

  • High blood pressure, which stresses the valve and aorta

  • Rheumatic heart disease (still common globally)

  • Endocarditis (valve infection)

  • Diseases of the aorta, such as aneurysm or dissection

  • Chest trauma or prior valve surgery

Risk Factors for Aortic Regurgitation

You may be at higher risk if you have:

  • A bicuspid aortic valve

  • Aortic disease affecting the ascending aorta

  • History of rheumatic fever

  • Chronic high blood pressure

  • Prior aortic valve replacement

How Aortic Regurgitation Affects the Heart

As regurgitation worsens:

  • The left ventricle enlarges to accommodate extra blood

  • Muscle walls may thicken, then weaken

  • Pumping efficiency declines

If untreated, this process can lead to heart failure, arrhythmias, and reduced survival. Acute AR can cause rapid fluid buildup in the lungs and requires immediate care.

How Echocardiography Diagnoses Aortic Regurgitation

Echocardiography is the gold standard for diagnosing and monitoring aortic regurgitation.

An echocardiogram allows clinicians to:

  • Visualize aortic valve anatomy and leaflet motion

  • Detect backward blood flow using color Doppler

  • Measure severity of regurgitation

  • Assess left ventricular size and function

  • Track disease progression over time

Doppler imaging is especially important because it shows the direction and volume of blood flow, not just valve structure.

Other tests may support evaluation, but echocardiography drives diagnosis and timing of intervention.

How Aortic Regurgitation Is Treated

Treatment depends on:

  • Severity of regurgitation

  • Presence of symptoms

  • Changes in heart size or function

Management options include:

  • Routine monitoring with echocardiography for mild disease

  • Medications to manage blood pressure or heart failure symptoms

  • Aortic valve repair or replacement for severe disease

Medications can improve symptoms but do not correct the leaky valve. Surgery or transcatheter intervention is the definitive treatment for advanced cases.

Why Early Detection Matters

Aortic regurgitation often progresses quietly. Waiting until symptoms appear may mean the heart has already sustained damage.

Regular echocardiographic follow-up helps:

  • Identify progression before symptoms worsen

  • Guide optimal timing for valve intervention

  • Preserve long-term heart function

The Bottom Line

Aortic regurgitation is a common valve condition that can range from mild and manageable to severe and life-threatening. Because symptoms often appear late, echocardiography plays a critical role in early diagnosis, severity assessment, and treatment planning.

If you have a heart murmur, known valve disease, unexplained shortness of breath, or a history of aortic or valve conditions, an echocardiogram is often the most important next step.

Aram Kerr
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What Is Tricuspid Regurgitation?