Aortic coarctation screening

, Associate Editor-in-Chief:

Overview
There are findings on physical examination that should prompt consideration of the diagnosis of aortic coarctation:

Blood Pressure
Arterial hypertension in the right arm with normal to low blood pressure in the lower extremities is classic. The blood pressure is higher in the upper extremities than in the lower extremities. The patient may complain of a headache due to hypertension.

Pulses
Femoral pulses are often diminished in strength. Exercise exacerbates this gradient.

If the coarctation is situated before the left subclavian artery, the left pulse will be diminished in strength and asynchronous radial pulses will be detected in the right and left arms. A radial-femoral delay between the right arm and the femoral artery may be apparent, while no such delay may be observed with left arm radial-femoral palpation.

A coarctation occurring after the left subclavian artery will produce synchronous radial pulses, but radial-femoral delay will be present under palpation in either arm.

Neck
There may be "webbing" of the neck in patients with Turner syndrome, 10% of whom have aortic coarctation.

Heart

 * A systolic ejection click is present when there is an associated bicuspid aortic valve.


 * The S2 is loud secondary to hypertension


 * An S4 may be present secondary to LVH


 * There are 3 potential sources of a murmur: arterial collaterals, an associated bicuspid aortic valve, and the coarctation itself which can be heard over the spine.


 * A prominent P2 may be present if there is associated pulmonary hypertension.

Extremities
Cyanosis of the lower extremities may be present.

Occasionally adults may have narrow hips and thin legs or have an undeveloped left arm (in those patients in which the coarctation compromises the origin of the subclavian artery).