Aortic insufficiency symptoms


 * Associate Editor-In-Chief:, 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 and left ventricular end diastolic pressure which manifests as:
 * Sudden and severe dyspnea
 * Chest pain if there is an aortic dissection

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 progression of AR, the compensatory mechanisms begin to fail causing gradual enlargement of the left ventricle, thereby progressively increasing left ventricular end diastolic pressure, decreasing stroke volume and cardiac output leading to left ventricular failure manifesting as:
 * Dyspnea on exertion
 * Orthopnea
 * Paroxysmal nocturnal dyspnea
 * Palpitations (due to compensatory tachycardia)
 * Chest pain (if left ventricular end diastolic pressure compromises coronary perfusion)

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