Coarctation of the aorta is a narrowing of the aorta, usually just past the left subclavian artery, present from birth. Severe cases cause heart failure or shock in newborns, while milder ones are often found later as high blood pressure in the arms with weak pulses in the legs.
Key symptoms
- Newborn: poor feeding, fast breathing, pale or gray skin
- Older child or adult: often no symptoms
- Headaches or nosebleeds from high blood pressure
- Leg pain or cold feet with exercise
- Shortness of breath
What you find on exam
- High blood pressure in the arms, lower in the legs
- Weak or delayed femoral pulses compared with the radial pulse (radio-femoral delay)
- Systolic murmur heard over the back between the shoulder blades
- Look for Turner syndrome features and the click of a bicuspid aortic valve
Tests
- Four-limb blood pressures; pulse oximetry on the right hand and a foot in newborns
- Echocardiogram
- CT or MR angiography to map the narrowing
- Chest X-ray in older patients: rib notching and a figure 3 sign
- ECG: left ventricular hypertrophy
Treatment basics
- Newborn in shock: prostaglandin E1 (alprostadil) to keep the ductus open
- Repair by surgery or by balloon angioplasty with a stent
- Control blood pressure, often with a beta blocker
- Lifelong follow-up for re-narrowing, aneurysm and high blood pressure
- Screen for a bicuspid aortic valve and brain aneurysm
Red flags
- Newborn with poor feeding, gray color or weak leg pulses
- Severe headache or chest pain with very high blood pressure
- Arm pressure higher than leg pressure in a young person with high blood pressure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.