aortic insufficiencies

Posted By  CCF Cardio MD-SGM on November 02, 1997 at 11:28:47:

In Reply to: aortic insufficiencies posted by Mary Ellen Rowan on November 01, 1997 at 17:42:50:

: I'm a 37 year old female and just diagnosed through an echo with Mod to severe aortic insufficiency.  Now taking 10 mg of Vasotec after still feeling much palpitations after 2 months on 5mg. Feel rather breathless and once in a while pain in upper right chest.  Was told three years ago that stress was causing palpitations.....extra heartbeats were detected on stat-halter then. Second echo will be done in December (6months after first per HMO rules).  Routine stress was fine....I am wondering if I should be concerned about finding out about "ejection %'s" especially when exercising, and whether any other tests should be done. Never have taken any diet drugs and have always been in good aerobic condition. Also, the vasotec cough is starting...what do I do?

[CCF Cardio MD-SGM]

Dear Mary,
You have asked some excellent questions which I will attempt to address. First, one must inquire as to the etiology of your AI(aortic insufficiency).  Common causes in your age group are rheumatic heart disease, bicuspid aortic valve(two cusps instead of the usual three), prior infection(endocarditis) of the aortic valve, and connective tissue disorders such as Marfan's syndrome that cause dilation of the aortic root.  I'm not sure which if any of these causes is operative here, but will continue with a discussion of AI management, since treatment and follow-up is similar for most of these categories.  
It's important to determine the degree of AI(mod to severe here), and measure baseline echocardiographic characteristics of Left Ventricular function such as end-systolic dimension, ejection fraction, exercise ejection fraction, and volumes.  ACE inhibitors(of which vasotec is one) are appropriate medications once AI has been discussed.   Antibiotic prophylaxis is recommended prior to dental procedures and other procedures, and diuretics(water-pills) may be considered, depending on your symptoms.  Palpitations are common symptoms with AI, but are most commonly managed with reassurance, and not specific medical therapies.  
Given that you are symptomatic, as marked by the breathlessness, and that the AI is in the mod-severe range by echo, then it is crucial to closely review serial echocardiograms in order to recommend valve replacement or repair prior to the development of irreversible injury to the left ventricle.  You see, AI is a condition of volume overload on the heart, as the blood that is ejected through the aortic valve flows back into the ventricle due to the insufficiency.  Eventually, this volume overload takes its toll on the ventricle, and permanent injury can occur.  I would recap that serial echo's are necessary to watch for signs of left ventricular injury in order to optimally time valve surgery.  If at all possible, when and if surgery becomes necessary, I recommend you have it done at a center which has vast experience in both repairing and replacing aortic valves.  If you'd like to see a cardiologist at the Cleveland Clinic, call 1-800 CCF-CARE and ask to make an appointment with a valve specialist at desk F15.  Best of luck.
Information provided by the Heart Forum is for general medical informational purposes.  Diagnosis and therapeutic suggestions can only be provided by your personal physician.