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Aortic Regurgitation - Symptoms
The symptoms of aortic valve regurgitation are those predominately of congestive heart failure. As chronic aortic regurgitation develops slowly over time, the left ventricle can easily compensate slowly as described previously.
This results in patients remaining asymptomatic for a long period of time early in disease. The first symptoms experienced may result from the large stroke volumes and forceful LV contractions causing the patient to experience palpitations. Angina may occur in the absence of atherosclerotic coronary disease since the low diastolic pressures in severe aortic regurgitation compromise coronary filling and the LVH results in increased oxygen demand.
Signs of left and right heart failure occur late in disease. Left heart failure results in symptoms related to the low cardiac output. The pressure increases in the left heart transmit to the lungs causing pulmonary edema and shortness of breath. With physical activity the heart demands increased cardiac output which is not able to be met in states of heart failure and thus left heart pressures increase significantly causing this transient pulmonary edema.
As those increased pressures from the left heart affect the right ventricle, right heart failure can ensue. The most common cause of right heart failure is left heart failure. Right heart failure symptoms include lower extremity dependant edema. When the legs are elevated at night, the fluid redistributes centrally causing pulmonary edema resulting in orthopnea (dyspnea while laying flat) or paroxysmal nocturnal dyspnea (PND). Hepatic congestion can occur causing right upper quadrant abdominal pain.
Other symptoms related to low cardiac output include fatigue, weakness and in extreme cases, cardiac cachexia can occur.
Almost all patients with significant acute aortic regurgitation are symptomatic, unlike chronic aortic regurgitation. Symptoms of acute left heart failure occur and include severe dyspnea even at rest, orthopnea, and PND. Hypotension and shock may occur.