COARCTATION OF THE AORTA

AETIOLOGY - narrowing of the aorta commonly occurs in the region where the ductus arteriosus joins the aorta (i.e. just below the origin of the left subclavian artery); often associated with other abnormalities (i.e. bicuspid aortic valve, aneurysm of the circle of Wilis); acquired coarctation - rare (i.e. follow trauma, Takayasu's disease)

CLINICAL FEATURES

sometimes it is a cause of cardiac failure in the newborn

often asymptomatic until the adulthood

coarctation is suspected when a patients with systemic hypertension is found to delayed femoral pulse (radial-femoral pulse lag) and 30mmHG or greater systolic pressure difference between the right arm and the legs

other signs: headaches, weakness or cramps in the legs, the upper extremities and thorax may be more developed than lower extremities, abnormally large arterial pulsations in the neck

sometimes systolic murmur posteriorly, over the coarctation, ejection systolic murmur in the aortic area (due to bicuspid valve)

collaterals involving the periscapular and intercostal arteries (systolic or continous murmurs over the lateral thoracic wall

CXR - changes in the contour of the aorta ("3 sign"), notching of the under surfaces of the ribs from collaterals (due to erosion by dillated vessels)

Category: Cardiology Notes