Which finding is most consistent with coarctation of the aorta?

Which finding is most consistent with coarctation of the aorta?

• A. Normal Blood Pressure in All Limbs
• B. Refractory Hypertension
• C. Delayed Femoral Pulses
• D. Chest Pain on Exertion

Answer: (B)

Coarctation of the aorta creates a fixed obstruction just after the branches to the upper body, so pressures build up proximal to the narrowing while distal pressures drop. The most telling clue is hypertension in the arms that is difficult to control with standard therapy—refractory hypertension—because the obstruction keeps a high afterload regardless of medications. This persistent proximal hypertension also drives left ventricular hypertrophy and related symptoms, making refractory hypertension a strong, overall marker of the lesion. Diminished or delayed femoral pulses can occur because distal flow is reduced, but this sign isn’t as universally present or as defining as the problem of hypertension that resists treatment. Chest pain on exertion is nonspecific and not unique to this condition, and normal blood pressure in all limbs would contradict the typical proximal hypertension seen with coarctation.

Coarctation of the aorta creates a fixed obstruction just after the branches to the upper body, so pressures build up proximal to the narrowing while distal pressures drop. The most telling clue is hypertension in the arms that is difficult to control with standard therapy—refractory hypertension—because the obstruction keeps a high afterload regardless of medications. This persistent proximal hypertension also drives left ventricular hypertrophy and related symptoms, making refractory hypertension a strong, overall marker of the lesion.

Diminished or delayed femoral pulses can occur because distal flow is reduced, but this sign isn’t as universally present or as defining as the problem of hypertension that resists treatment. Chest pain on exertion is nonspecific and not unique to this condition, and normal blood pressure in all limbs would contradict the typical proximal hypertension seen with coarctation.