Aortic valve regurgitation: Chronic vs. acute

Chronic and acute aortic valve (AV) regurgitation differ in their onset, symptoms, causes, and treatment. Determining whether you have acute or chronic regurgitation is important because the timing of treatment is very different. The acute condition is a medical emergency that requires immediate surgical intervention to prevent death. Chronic regurgitation, however, may not need to be treated immediately with surgery. In fact, it is advisable not to treat it surgically until it is bad enough to justify the risk of surgical intervention.

This table shows the primary differences between the two conditions.

Chronic aortic valve regurgitation

As the name implies, chronic regurgitation is a condition that you will have over a long period of time, usually many years. It can worsen the longer you have it. Chronic aortic valve regurgitation usually is not much of a problem when you are initially diagnosed, but as your heart compensates for the regurgitation, it eventually weakens. This causes the regurgitation to worsen until you need surgical treatment. Surgery for a chronic condition is generally avoided until it is necessary to preserve your heart function.

Additionally, most people do not have any symptoms when they develop chronic regurgitation. It is not until later stages of the condition that most people notice symptoms.

Acute aortic valve regurgitation

Acute regurgitation is caused by infection in the heart (endocarditis), separation of the inner layer of the aorta from the middle layer (aortic dissection), or trauma. The net result of aortic dissection is a large amount of blood suddenly leaking back into the left ventricle. Your heart has not had time to develop coping mechanisms for leaking blood. This may cause your heart to beat very rapidly in an attempt to move enough blood through your body, but often this is not enough, and surgical intervention is needed.

Unlike the chronic condition, the rapid onset of acute regurgitation does cause symptoms immediately. Rapid heartbeat (tachycardia) is a common symptom as the heart tries to increase the volume of blood that it pumps. Acute regurgitation can also lead to other irregular heartbeats (arrhythmias), fluid buildup in the lungs (pulmonary edema), and critically low blood output by the heart (cardiogenic shock), all of which can cause sudden death. It is imperative that you seek surgical treatment for acute regurgitation immediately to prevent this.