Chronic severe aortic regurgitation can stay silent for years while the left ventricle dilates. Waiting for breathlessness risks irreversible dysfunction, so surveillance echo matters as much as the history.
Refer for intervention when a patient with severe regurgitation develops symptoms, or when the ejection fraction falls or the end-systolic dimension keeps rising on serial echo. Diastolic pressure and a wide pulse pressure are clues, not a substitute for imaging.
- Arrange regular echo surveillance for asymptomatic severe aortic regurgitation.
- Refer promptly when symptoms appear, even if the ejection fraction is preserved.
- Refer when serial echoes show a falling ejection fraction or a growing end-systolic dimension.
- Ask specifically about exertional breathlessness, which patients often attribute to age.
Why it matters
Ventricular damage in aortic regurgitation can become permanent before the patient feels unwell.
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