Thursday, 7 October 2010

MRCP revision battle 26.5: Coarctation of the aorta

Coarctation of the aorta (=narrowing of the aorta) classically occurs just distal to the left subclavian artery.

It may present at birth with heart failure, or be discovered later in life, eg during investigation for hypertension.

Most adults with coarctation of the aorta are asymptomatic.  Occasionally they may complain of:
  • headache
  • recurrent epistaxis
  • claudication of the calf muscles

Clinical examination may reveal:
  • radio-femoral delay
  • midsystolic murmur

Complications of coarctation include:
  • hypertension
  • LVF
  • endocarditis

Conditions associated with coarctation include:
  • bicuspid aortic valve (10-20%)
  • PDA
  • VSD
  • Berry aneurysms
  • Turners syndrome
  • renal abnormalities

CXR may show rib notching due to formation of collaterals

Management is stenting/surgery.

Now for the penultimate battle of the day, heparin...