<unk>  insufficiency refers to the retrograde or backward flow of blood from the aorta into the left ventricle during diastole. When the pressure in the left ventricle falls below the pressure in the aorta, the<unk>  valve is not able to completely close. This causes a leaking of blood from the aorta into the left ventricle. The percentage of blood that regurgitates back through the<unk>  valve due to AI is known as the regurgitant fraction. The prevalence of<unk>  varies with age, geographic location, and gender.<unk>  insufficiency is unusual before the age of 50 and then increases progressively later in life.<unk>  is more commonly seen in men as compared to women. Worldwide the most common cause of<unk>  insufficiency is the rheumatic heart disease, particularly in the Asia, the Middle East, and the North Africa. In the United States, senile degenerative calcific<unk>  valve disease and bicuspid<unk>  valve disease<unk> e the most common causes. The Framingham Heart Study, a prospective epidemiological study, evaluated the prevalence and severity of<unk>  and other valvular diseases by color Doppler examinations in 1,696 men and 1,893 women. In acute<unk>  insufficiency symptoms of heart failure often develop acutely. Chronic<unk>  insufficiency is usually insidious and progressive and the patient may remain asymptomatic for years. Once left ventricular dilation and left ventricular failure occur, dyspnea on exertion and exercise intolerance begin to occur. Later symptoms such as angina, syncope, and other symptoms of heart failure<unk> e present. There<unk> e two main parameters that reflect the overall outcome in patients with<unk>  insufficiency: ejection fraction (the lower the ejection fraction, the poorer the outcome) and end systolic diameter. Left ventricular dysfunction develops in patients with<unk>  insufficiency after decades of the onset of the symptoms. This lag period is longer than that of mitral regurgitation. A detailed history and physical exam and diagnostic techniques like electrocardiogram, chest X-ray, echocardiography and a cardiac MRI can be used to diagnose<unk> . The symptoms of acute<unk>  <unk>  include dyspnea, chest pain (when<unk>  dissection is the cause of<unk> , weakness, and symptoms of congestive heart failure. Chronic<unk>  may be without symptoms for several years until there is a decrease in the stroke volume and cardiac output due to heart failure progression. Symptoms of chronic<unk>  insufficiency include exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, and palpitations. The echocardiogram is the single most useful diagnostic imaging study in the diagnosis and ongoing surveillance of the severity of<unk>  insufficiency. Echocardiography allows for serial assessment of left ventricular volumes which can be critical in determining the timing of<unk>  valve replacement.  Echocardiography is used to assess the following parameters: end-diastolic diameter, end systolic diameter, and ejection fraction.<unk>  valve replacement should be performed if the LVEF is ≤ 55% or if left ventricular end-systolic dimension is > 55mm. Pulsed Doppler echocardiography is more sensitive than auscultation specially in patients in whom no murmur is observed. Cardiac MRI may be used for assessing individuals with valvular heart disease in which evaluation of valvular stenosis, regurgitation, para- or perivalvular masses, perivalvular complications of infectious processes, or prosthetic valve disease<unk> e needed. CMR may be useful in identifying serial changes in LV volumes or mass in patients with valvular dysfunction.<unk>  insufficiency can be treated either medically with vasodilators or surgically with<unk>  valve replacement, depending upon the acuteness of presentation, the symptoms and signs associated with the disease process, and the degree of left ventricular dysfunction. Nitroprusside and ionotropes can be used to maintain blood pressure.  Treatment options that<unk> e contraindicated include intra<unk>  balloon pump, pressors, and beta blockers (except in<unk>  dissection, where beta blockers can be used cautiously).
Aortic regurgitation
Mitral regurgitation
Mitral stenosis
Tricuspid regurgitation
Aortic stenosis
Tricuspid stenosis
Pulmonic regurgitation
Aortic insufficiency