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Showing posts with label coarctation of aorta. Show all posts
Showing posts with label coarctation of aorta. Show all posts

Interesting features of Coarctation of Aorta

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
Clinical signs in coarctation
  • 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
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
Treatment of coactation
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. 

Causes of pulsation at back

Causes of pulsation at back are
  • Coarctation of aorta (Suzman’s sign)
  • Pulmonary AV fistula

What are the symptoms of Coarctation of the aorta?

Coarctation of the aorta is the narrowing of the descending aorta, it is typically located at the insertion of the ductus arteriosus just distal to the origin of  left subclavian artery. Coarctation will generally results in left ventricular pressure overload. Narrowing or constriction of the lumen of the aorta may occur anywhere along its length but it is most common distal to the origin of the left subclavian artery near the insertion of the ligamentum arteriosum.
What are the factors affect the symptoms of coactation?
Symptoms of Coarctation of the aorta depend on the severity of the condition. Most people donot have symptoms. Children with serious aortic narrowing will show signs and symptoms earlier in life, but mild cases who are asymptomatic are not diagnosed until adulthood.
Clinical symptoms  of coarcation depend on 
  • The site and extent of obstruction  
  • Presence of associated cardiac anomalies; such as a bicuspid aortic valve. Circle of Willis aneurysms 
  • Age of the patient
Symptoms of coarctation according to age 
Symptoms in the neonates
The symptoms in newborns with coarctation vary with the severity of the constriction of the aorta. According to KidsHealth, most newborns babies with Coarctation show no symptoms.About fifty percentage of newborns with this problem will manifest certain symptoms in the first few days of life. Babies with severe coarctation of the aorta may begin having signs and symptoms immediately after birth. These include:
  • Pale skin
  • increased irritability 
  • Heavy sweating
  • Difficulty breathing
  • Difficulty feeding
  • Increased sleepiness or becoming poorly responsive
  • Left untreated, aortic coarctation in babies might lead to heart failure or death.
In milder cases, symptoms may not develop until the child has reached adolescence. 
Most children and young adults with isolated, discrete coarctation are asymptomatic. There are also certain symptoms which give clue to underlying diagnosis.
Older infants and children in this group the diagnosis is often delayed because most patients are asymptomatic and physical findings are subtle 
The classic presenting sign is hypertension
Symptoms in adults people  
  • Pounding Headache
  • Epistaxis
  • Cold extremities 
  • Claudication with exercise may occur,
  • Chest pain
  • Heart failure
  • Aortic dissection
  • High blood pressure
  • Muscle weakness
  • Leg cramps or cold feet
  • Chest pain
  • Dizziness or fainting
  • Decreased ability to exercise
  • Failure to thrive
  • Shortness of breath 
Clinical sign that lead to diagnosis of coarctation are
  • Presence of heart murmur 
  • Presence of hypertension
  • Hypertension in the upper extremities 
  • A clinical diagnosis of coarctation is made if there is an absent or delayed femoral pulse compared with the brachial pulse.
  • Enlarged and pulsatile collateral vessels may be palpated in the intercostal spaces anteriorly, in the axillae, or posteriorly in the interscapular area. 
  • The upper extremities and thorax are more developed compared to the lower extremities.
  • A midsystolic murmur is heard over the left interscapular space it become continuous if the lumen is narrowed sufficiently to result in a high velocity jet across the lesion throughout the cardiac cycle. 
  • Additional systolic and continuous murmurs is noted over the lateral thoracic wall it may reflect increased flow through dilated and tortuous collateral vessels. 
Common complications in Coarctation of aorta
  • Systemic hypertension
  • Accelerated coronary artery disease
  • Stroke 
  • Aortic dissection
  • Heart failure

Related topics
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