I cannot cast an ultimate on myself using alt + r (for example, ancestral healing) - I used to be able to do that. alt+q, alt +w, alt + 1 etc is workingas usual. the hotkey menu under hero abilities (self cast) shows that alt + r is bound correctly as the hotkey for ultimate self cast but for some reason it does not work.
When I change it to alt + ctrl, it does work.
Please advise.
You have to start troubleshooting somewhere. Are you perhaps using some kind of a keyboard with its own software? Try if your key opens up a talent menu, if it does, it means you’ve got an Alt gr key in that spot.
Alt gr is a modifier key. Look around your windows keyboard layout options or any overwriting software (branded hardware) that might be causing you problems. All you have to do is change the key to a regular Alt.
This is same as in WoW where you might be spamming one key that you have bound to a certain action, but it will not register because your language and layout settings may have switched. The game is in that case receiving an entirely different command that does not correspond to anything you may have set up previously.
https://w3c.github.io/uievents/tools/key-event-viewer.html
Play around for yourself to see what the left and right buttons are actually doing.
Reghar cant use ancestral on himself. That was patched quite a long time ago.
After 1 second, heal an allied Hero for 1180 Health<
The alt key seems to be a normal alt key, but it is only unresponsive when using ultimate. I am using a laptop and it doesn’t work on my laptop’s keyboard as well as on an external one.
I think they may have patched it in again
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I had this same problem. Just found out that there was an ALT + R keybind in my nvidia gforce overlay which was stopping hots from using ALT + R. It was the same for me that the right alt was working or if i pressed ctrl + alt + R.
If you have an Nvidia GPU might wanna look into the Nvidia Gforce experience overlay and unbind whatever is bound to ALT + R in there. It did the trick for me! 
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Had this exact issue. Go into your tray icons and just close a bunch of stuff - check if that solved the issue. If it did, just go and look for a keybind that some of those tray programs might have enabled. I had Alt+R taken by Dell Display Manager… go figure.
This was the exact problem I was having. After reading your reply and looking over at my hots I saw the nvidia performance overlay.