Aortic regurgitation is the flow of blood back into the left ventricle from the aorta during diastole. It may be caused by inflammatory lesions that deform the aortic valve leaflets or dilation of the aorta, preventing complete closure of the aortic valve, or it may result from infective or rheumatic endocarditis, congenital abnormalities, diseases such as syphilis, a dissecting aneurysm that causes dilation or tearing of the ascending aorta, blunt chest trauma, or deterioration of a surgically placed aortic valve.
Prevention
Prevention and treatment of bacterial infections is key. See Endocarditis, Rheumatic in Section E.
In addition to the blood normally delivered by the left atrium, blood from the aorta returns to the left ventricle during diastole. This causes the left ventricle to dilate and eventually hypertrophy, resulting in increases in systolic pressure. Arteries attempt to compensate for the higher pressures by reflex vasodilation; the peripheral arterioles relax, reducing peripheral resistance and diastolic blood pressure.
- Advise patient to avoid physical exertion, competitive sports, and isometric exercise.
- Treat dysrhythmias and heart failure.
Pharmacologic Therapy
There is no strong indication for medical therapy based on findings from clinical trials. Patients with aortic regurgitation and also hypertension should be treated with dihydropyridine calcium channel blockers (e.g., felodipine [Plendil], nifedipine [Adalat, Procardia]) or ACE inhibitors (e.g., captopril, enalapril, lisinopril, ramipril) to provide afterload reduction.
Quality and Safety Nursing Alert
| The calcium channel blockers diltiazem [Cardizem] and verapamil [Calan, Isoptin] are contraindicated for patients with aortic regurgitation as they decrease ventricular contractility and may cause bradycardia. |
Surgical Management
The treatment of choice is aortic valve replacement or valvuloplasty, preferably performed before left ventricular failure occurs. Surgery is recommended for any patient with left ventricular hypertrophy, regardless of the presence or absence of symptoms.
Outline
See Perioperative Nursing Management in Section P for additional information.
- Teach patient about wound care, diet, activity, medication, and self-care.
- Instruct patient on importance of antibiotic prophylaxis to prevent endocarditis.
- Reinforce all new information and self-care instructions for 4 to 8 weeks after the procedure.
For more information, see Chapter 28 in Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth's textbook of medical-surgical nursing (14th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.