Aortic coarctation overview: Difference between revisions
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{{Template:Aortic Coarctation}} | {{Template:Aortic Coarctation}} | ||
{{CMG}} | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]][mailto:psingh@perfuse.org], {{CZ}}; '''Assistant Editor(s)-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]][mailto:kfeeney@perfuse.org] | ||
'''Associate Editor- | |||
==Overview== | ==Overview== | ||
'''Aortic coarctation''' is a localized narrowing or abrupt constriction of the [[aortic arch]] anywhere along its length. It is most common distal to the origin of the left [[subclavian artery]], near the area where the ductus arteriosus ([[ligamentum arteriosum]] after its regression) inserts. Less commonly, the obstruction can occur in the abdominal [[aorta]]. Coarctation may be associated with bicuspid [[aortic stenosis]]. | '''Aortic coarctation''' is a localized narrowing or abrupt constriction of the [[aortic arch]] anywhere along its length. It is most common distal to the origin of the left [[subclavian artery]], near the area where the ductus arteriosus ([[ligamentum arteriosum]] after its regression) inserts. Less commonly, the obstruction can occur in the abdominal [[aorta]]. Coarctation may be associated with bicuspid [[aortic stenosis]]. | ||
There is a dilation of the aorta immediately above the narrowing, but especially just below. Therefore the latin term "coarctatus", which means contracted or tightened. | There is a dilation of the aorta immediately above the narrowing, but especially just below. Therefore the latin term "coarctatus", which means contracted or tightened. | ||
==Causes== | ==Causes== | ||
Like many [[congenital heart disease]]s, the cause of aortic coarctation is not clear. The etiology of coarctation of the aorta may be explained by multifactorial inheritance hypothesis. Clinical studies suggest that genetic, familial influence and environmental factors both play an important role during pregnancy. It has been found to be associated more with patients with [[turner syndrome]]. Additional research suggests a possible link between other congenital heart diseases and an aortic coarctation, indicating that those with congenital heart disease are more likely to have an accompanying secondary defect. | Like many [[congenital heart disease]]s, the cause of aortic coarctation is not clear. The etiology of coarctation of the aorta may be explained by multifactorial inheritance hypothesis. Clinical studies suggest that genetic, familial influence and environmental factors both play an important role during pregnancy. It has been found to be associated more with patients with [[turner syndrome]]. Additional research suggests a possible link between other congenital heart diseases and an aortic coarctation, indicating that those with congenital heart disease are more likely to have an accompanying secondary defect. | ||
==Physical examination== | ==Physical examination== | ||
Physical examination acts as an important tool in the diagnosis of [[coarctation of aorta]]. Differential hypertension (depending on the location of coarctation)with increased blood pressure in upper limb and hypotension in lower extremities. The difference is usually in systolic blood pressure whereas the diastolic blood pressures are typically similar. Similarly, the pulses in upper extremities are bounding whereas the femoral pulses are often diminished (brachial-femoral delay). There are 3 potential sources of a murmur: multiple arterial collateral (continuous murmur), an associated [[bicuspid aortic valve]] (systolic ejection click), and the coarctation itself which can be heard over the left infraclavicular area and under scapula. Murmurs due to associated cardiac abnormalities such as VSD or aortic valve stenosis, may also be detected. Neonates may present with discrepancies in blood pressure and pulses between the limbs, differential [[cyanosis]] or reversed differential cyanosis (depending on associated lesions), [[murmur]], [[congestive heart failure]], and [[shock]]. Older children and adolescent may be referred due to agitated behavior, headache, vision problem, and [[hypertension]]. | Physical examination acts as an important tool in the diagnosis of [[coarctation of aorta]]. Differential hypertension (depending on the location of coarctation)with increased blood pressure in upper limb and hypotension in lower extremities. The difference is usually in systolic blood pressure whereas the diastolic blood pressures are typically similar. Similarly, the pulses in upper extremities are bounding whereas the femoral pulses are often diminished (brachial-femoral delay). There are 3 potential sources of a murmur: multiple arterial collateral (continuous murmur), an associated [[bicuspid aortic valve]] (systolic ejection click), and the coarctation itself which can be heard over the left infraclavicular area and under scapula. Murmurs due to associated cardiac abnormalities such as VSD or aortic valve stenosis, may also be detected. Neonates may present with discrepancies in blood pressure and pulses between the limbs, differential [[cyanosis]] or reversed differential cyanosis (depending on associated lesions), [[murmur]], [[congestive heart failure]], and [[shock]]. Older children and adolescent may be referred due to agitated behavior, headache, vision problem, and [[hypertension]]. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:12, 12 April 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S.[2], Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S.[4]
Overview
Aortic coarctation is a localized narrowing or abrupt constriction of the aortic arch anywhere along its length. It is most common distal to the origin of the left subclavian artery, near the area where the ductus arteriosus (ligamentum arteriosum after its regression) inserts. Less commonly, the obstruction can occur in the abdominal aorta. Coarctation may be associated with bicuspid aortic stenosis. There is a dilation of the aorta immediately above the narrowing, but especially just below. Therefore the latin term "coarctatus", which means contracted or tightened.
Causes
Like many congenital heart diseases, the cause of aortic coarctation is not clear. The etiology of coarctation of the aorta may be explained by multifactorial inheritance hypothesis. Clinical studies suggest that genetic, familial influence and environmental factors both play an important role during pregnancy. It has been found to be associated more with patients with turner syndrome. Additional research suggests a possible link between other congenital heart diseases and an aortic coarctation, indicating that those with congenital heart disease are more likely to have an accompanying secondary defect.
Physical examination
Physical examination acts as an important tool in the diagnosis of coarctation of aorta. Differential hypertension (depending on the location of coarctation)with increased blood pressure in upper limb and hypotension in lower extremities. The difference is usually in systolic blood pressure whereas the diastolic blood pressures are typically similar. Similarly, the pulses in upper extremities are bounding whereas the femoral pulses are often diminished (brachial-femoral delay). There are 3 potential sources of a murmur: multiple arterial collateral (continuous murmur), an associated bicuspid aortic valve (systolic ejection click), and the coarctation itself which can be heard over the left infraclavicular area and under scapula. Murmurs due to associated cardiac abnormalities such as VSD or aortic valve stenosis, may also be detected. Neonates may present with discrepancies in blood pressure and pulses between the limbs, differential cyanosis or reversed differential cyanosis (depending on associated lesions), murmur, congestive heart failure, and shock. Older children and adolescent may be referred due to agitated behavior, headache, vision problem, and hypertension.