AR is the diastolic leakage of blood from the aorta into the left ventricle

It occurs due to inadequate coaptation of valve leaflets resulting from either:

• intrinsic valve disease
• dilation of the aortic root

It can remain asymptomatic for decades before patients present with irreversible myocardial damage and heart failure due to left ventricular systolic dysfunction.

Aetiology

Causes (due to valve disease)

• rheumatic fever (most common in the developing world)
• calcific valve disease
• infective endocarditis
• connective tissue diseases e.g. RA/SLE
• bicuspid aortic valve (affects the valves and aortic root)

Causes (due to aortic root disease)

• bicuspid aortic valve (affects the valves and aortic root)
• aortic dissection
• spondylarthropathies (e.g. ankylosing spondylitis)
• hypertension
• syphilis
• Marfan's, Ehler-Danlos syndrome