Aortic Coarctation Flashcards

1
Q

What is aortic coarctation?

A

Constriction of a segment of the aorta, usually near the ductus arteriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the types of aortic coarctation?

A
○ Infantile - pre-ductal
○ Adult
	- Juxta-ductal (most common): usually occurs at the time of closure of ductus arteriosus
	- Post-ductal
	- Middle aortic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors for aortic coarctation

A
  • Male gender
  • Young age
  • Turner’s syndrome
  • DiGeorge’s syndrome
  • Hypoplastic left heart syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Signs and symptoms of aortic coarctation

A

May be asymptomatic in setting of non-severe stenosis:

Sx: chest pain, arrhythmia Sx, claudication, renal failure Sx, cyanosis

Signs:

  • inc upper limb BP, arterial hypertension
  • systolic murmur
  • laterally displaced apex beat
  • lower extremity pulses diminished or delayed
  • radio-femoral delay
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the pathophysiology of aortic coarctation (i.e. how does it lead to its signs and symptoms?

A
Narrowing of aorta causes:
• Increased blood flow to upper limb and decreased blood flow to lower limb
	○ Weak femoral pulses
	○ Increased upper limb blood pressure
	○ Radio-femoral delay
• Increased afterload
	○ Laterally shifted apex beat
	○ LVH→Systolic murmur
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some Ix you should do for aortic coarctation?

A
  • ECG
  • CXR
  • (GS) Echo: discrete narrowing in thoracic aorta, pressure gradient across narrowing
  • CT angiography, MR angiography
    Cardiac catherisation: gradient of above 20 mmHg across coarctation is indicative of severe coarctation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some CXR findings for aortic coarctation?

A
  • Cardiomegaly
  • ‘3’sign at site of coarctation representing pre- and post-coarctation dilatations
    erosions of anterior ribs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why is aortic coarctation well tolerated in utero?

A

Because blood is shunted across PDA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Outline the management for

A
  • Lifelong cardiology follow-up
  • neonates: PGE1administration to maintain patency of ductus arteriosus
  • surgical repair:
    • end-to-end anastomosis
    • arch reconstruction with placement of patch (medium-length narrowing)
    • bypass graft (long narrowings) +/- stent (older kids)
  • balloon angioplasty
  • Meds to control hypertension (beta-blockers, ACE inhibitors, AngR blockers, cardiac glycosides, loop diuretics)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly