THE CONTEXT
Aortic coarctation produces contrasting circulatory findings in the upper and lower body, with additional signs from associated valve disease and collateral vessels.
Presentation and blood pressure
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Coarctation is an important cause of cardiac failure in newborns, whereas older children and adults often have no symptoms.
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Hypertension proximal to the coarctation may cause headaches. Reduced lower-body circulation may occasionally cause leg weakness or cramps.
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Blood pressure is raised in the upper body but normal or low in the legs.
Pulses, murmurs and collaterals
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Femoral pulses are weak and delayed compared with the radial pulse.
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A systolic murmur is usually heard posteriorly over the coarctation.
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An associated bicuspid aortic valve may cause an ejection click and systolic murmur in the aortic area.
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Collateral vessels mainly involve the periscapular, internal mammary and intercostal arteries and may produce localised bruits.