What are the physical findings in the late presentation of coarctation of the aorta (CoA)?

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Older infants and children may be referred for evaluation of hypertension or murmur. Hypertension in a fussy infant or a child may be attributed to agitation; thus, comparing BP readings in all the 4 extremities is important. Occasionally, the left arm pressure is lower than the right arm pressure if the origin of the left subclavian artery is involved in the coarctation. Similarly, anomalous origin of the right subclavian artery (below the level of coarctation) may produce decreased or absent right brachial pulse. Careful simultaneous palpation of upper and lower extremity pulses may help confirm suspected coarctation.

In older children, adolescents, and adults, coarctation of the aorta is best diagnosed clinically based on simultaneous palpation of femoral and brachial pulses. Blood pressure in both arms and one leg must be determined; a pressure difference of more than 20 mm Hg in favor of the arms may be considered evidence of coarctation of the aorta.

A murmur in the left infraclavicular area and under the left scapula may be systolic, but the murmur may also sound continuous in the presence of multiple collateral vessels or, occasionally, severe coarctation. An ejection click may be audible when an associated bicuspid aortic valve and a murmur of aortic stenosis or insufficiency are present. Similarly, a murmur of mitral stenosis or LV outflow tract obstruction may also occur. A gallop rhythm may occur in the presence of a hypertrophic noncompliant LV.

Other findings on physical examination may include abnormalities of blood vessels in the retina and a prominent suprasternal notch pulsation. A thrill may be present in the suprasternal notch or on the precordium in the presence of significant aortic valve stenosis. In the rare case of abdominal coarctation, an abdominal bruit may be noted.


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