Aortic Coarctation Flashcards
1
Q
What is aortic coarctation?
A
Constriction of a segment of the aorta, usually near the ductus arteriosus
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
3
Q
Risk factors for aortic coarctation
A
- Male gender
- Young age
- Turner’s syndrome
- DiGeorge’s syndrome
- Hypoplastic left heart syndrome
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
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
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
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
8
Q
Why is aortic coarctation well tolerated in utero?
A
Because blood is shunted across PDA
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)