Causes | Aortic valve insufficiency


Congenital aortic valve insufficiency is rarely found. One cause of a congenital form would be a so-called bicuspid aortic valve, an aortic valve with only two pockets. However, the aortic valve usually consists of three pockets, which is why a healthy aortic valve is called a tricuspid aortic valve.

If the aortic valve insufficiency does not exist from birth, the causes vary depending on whether the insufficient closure of the aortic valve is acute or chronic, i.e. develops over years or decades. Acute aortic valve insufficiency is usually caused by bacterial colonisation of the valve as part of a bacterial inflammation of the inner heart skin (endocarditis). Less frequent causes are trauma or acute splitting of the wall layers of the aorta (aortic dissection).

Frequency distribution

The aortic valve is the heart valve that most often has an acquired heart valve defect. However, in the majority of cases a so-called aortic valve stenosis, i.e. a narrowing of the aortic valve, is present. The aortic valve insufficiency described here occurs less frequently. Aortic valve insufficiency, regardless of its severity, is found in about 10% of the population. Men are more frequently affected than women.


Acute aortic valve insufficiency presents itself as a serious clinical picture with acute left heart failure, which means that the left ventricle is no longer able to supply the body with sufficient blood. This leads to a drop in blood pressure, to which the body reacts with an increase in heart rate, which can be perceived as tachycardia. In its maximum form, this condition can lead to cardiogenic shock, which means that the heart does not provide enough blood for the body’s organs and also for itself.

Because the blood is not transported into the body in sufficient quantity, it accumulates via the left atrium back into the pulmonary circulation and causes a water lung (pulmonary oedema) with shortness of breath. In contrast to the pronounced symptoms of acute aortic valve insufficiency, chronic aortic valve insufficiency can cause no symptoms for years or decades. Typical and relatively specific for chronic aortic valve insufficiency is a high blood pressure amplitude with values of 180/40 mmHg, for example.

This means that there is a high systolic and a low diastolic blood pressure value. This causes a large and rapid pulse, which is called pulsus celer et altus (“water hammer pulse”). Furthermore, the systolic blood pressure value at the legs may be more than 60 mmHg above the systolic blood pressure of the arms (Hill phenomenon).

Other pulsation phenomena can also be detected. These include, for example, a pulse-synchronous booming of the head, pulse-synchronous nodding of the head (Musset’s sign), pulse-synchronous pulsations of the uvula or pulsating carotid arteries. After many years of complete freedom from symptoms, a reduction in performance and rapid fatigue can be recorded. Symptoms that appear later also include shortness of breath due to the backlog of blood in the lungs, chest pain (angina pectoris) due to the reduced blood supply to the coronary vessels and left heart failure (the left ventricle of the heart can no longer supply the body’s organs with sufficient blood). You can also find detailed information under Symptoms of Heart Failure.