Clinical presentation of coarctation
Most patients are asymptomatic
Symptomatic patients usually present with :
- Headache
- Dizziness
- Epistaxis
- Cold extremities
- Weakness in the legs
- Claudication with exercise
- Hypertension in upper extremities with marked derease of pulsation in lower extremities.
- Mid systolic or continuous murmur over anterior part of chest and back
- Enlarged and pulsatile collateral vessels in intercostal spaces anteriorly in axilla or posteriorly in interscapular area
- Upper extremity and thorax may be more developed in these patients than lower extremities.
ECG: shows left
ventricular hypertrophy
Radiography:
Indentation of aorta at site of coarctation and '3 sign' on
paramediastinal shaddon are almost pathogenic of coarctation
Notching (erosion) of inferior surfaces of ribs.
Complications of coartation
- Cerebral aneurysms and haemorrhage
- Rupture of aorta
- Left ventricular failure
- Infective endocarditis
In surgical resection
of 'coarctation' and end to end anastomosis
Remember that Hypertension may not he corrected even after
surgical correction of the 'coarctation'.
Interesting facts about coarctation
- Most common site of coarctation of aorta is distal to origin of left subclavian artery.
- Most common associated cardiac anomaly is bicuspid aortic valve.
- It may be associated with Turner's syndrome.
