Difficulties in diagnosing aortic valve regurgitation

Content provided by Healthwise

Difficulties in diagnosing aortic valve regurgitation

Heart valve conditions can be difficult to diagnose, particularly because they often have no symptoms. The following situations can make diagnosing aortic valve regurgitation difficult.

Lack of routine physical examinations

Most valve problems are discovered by a doctor while listening to the heart with a stethoscope. If you do not have routine physicals, it is unlikely to be diagnosed unless you go to a doctor for a different medical problem. You should have a physical exam periodically, with the frequency depending on your age, overall health, and risk factors for various conditions.

If a doctor finds aortic valve regurgitation during a routine physical, your condition will likely not have progressed to the point of being severe and needing immediate treatment. By treating regurgitation early, you may be able to extend, possibly even by several years, the time before you need valve replacement surgery. Because all artificial valves eventually wear out, this could mean one fewer valve replacement in your lifetime.

Not seeing a doctor when you develop symptoms

The most common symptoms of valve problems, chest pain (angina) and shortness of breath, are often mistaken for heartburn or being out of shape. If you experience either of these symptoms, you should see your doctor (for a routine physical if you have not had one lately) even though the symptoms could be caused by a wide range of conditions, some of which are serious and some insignificant.

For aortic valve regurgitation in particular, symptoms often mean that your condition has progressed to a later stage, because regurgitation is usually asymptomatic until more advanced stages. You might well be at a point that your aortic valve will need to be replaced. Seeing your doctor will confirm whether you have valve problems or some other condition.

Failure to recognize an acute condition

Acute aortic regurgitation sometimes is misdiagnosed because it does not exhibit the classic signs of regurgitation, and so it is often mistaken for a different or less severe valve problem. Specifically, the large stroke volume that characterizes severe chronic aortic valve regurgitation is missing because your heart has not had time to stretch to accommodate the additional blood that is leaking back into the left ventricle.

Because your heart has not compensated for the regurgitation, you can immediately develop heart failure. Therefore, acute regurgitation is a surgical emergency and must be treated immediately. It is imperative if your doctor suspects an acute condition that you have an echocardiogram to assess the severity of the regurgitation.

Not having an echo

Whenever you are diagnosed with a valve problem, you should have an echocardiogram. An echocardiogram will allow your doctor to more accurately confirm the diagnosis and assess the severity of the regurgitation. The condition can be mistaken for other valve problems; an echocardiogram will eliminate any doubt. This is particularly important because the later stages of aortic valve regurgitation will begin to sound like narrowing of the mitral valve (mitral valve stenosis), and its severity could be therefore underestimated.

Failure to diagnose coronary artery disease

Coronary artery disease (CAD) and valvular problems can often be confused because the two have similar symptoms. Valvular problems, however, are easier to diagnose, because they can often be heard through a stethoscope. You and your doctor should still investigate the possibility that you have CAD by assessing your risk factors and symptoms. If they indicate you might have CAD, you will probably need an angiogram, a test in which a catheter is inserted into an artery that goes to your heart, a dye is injected, and X-rays are taken.

CAD also can cause heart failure. The surgery used to treat CAD can often be performed while your valve is being replaced.

Credits

Last updated:	January 24, 2008
Author:	Robin Parks, MS
Reviewed By:	E. Gregory Thompson, MD - Internal Medicine, Stephen Fort, MD, MRCP, FRCPC - Interventional Cardiology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC