Pathophysiology of Coarctation of Aorta
1) coarctation of aorta is a congenital narrowing of the aorta
2) it can occur anywhere along the length of the aorta, but most common site is just distal to the take off of the left subclavian artery
Type I Coarctation  of Aorta
3) narrowing is distal to left subclavian artery but proximal to insertion of ductus arteriosus
Type II Coarctation of Aorta
narrowing is distal to insertion of ductus arteriosus
Signs and Symptom of Coarctation of Aorta
1) upper extremity hypertension
2) weak femoral pulses
3) “radial-femoral” delay in pulses
4) pulsatile vessels in intracostal spaces
5) headache
6) nose bleeds (epistaxis)
7) claudication in legs
8) cool legs
9) continuous murmur over spine
Characteristic Test Findings
Radiology
1) notching of ribs on chest radiograph is highly characteristic of coarctation of aorta
2) “3” sign seen at left paramedian edge on chest radiograph (from indentation of aorta and pre- and post-narrowing dilatation
3) right ventricular hypertrophy in utero (preductal type)
ECG
4) left ventricular hypertrophy (tall QRS complexes) occurs in coarctation of aorta
Associated Conditions
1) Turner’s syndrome (Type I or preductal)
2) congenital bicuspid valve
3) gonadal dysgenesis
4) cerebral aneurysms
5) infective endocarditis
6) cerebral hemorrhage
7) early arteriosclerosis
8) male to female, 3:1
Treatment
resection with end-to-end anastomosis
Tips for USMLE
1) if questions is about an 11 year old girl with Turner’s syndrome who has developed a murmur that is continuous and best heard over the upper middle back, think coarctation of aorta
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