coarctation of the aorta, a congenital cardiac anomaly characterized by a localized narrowing of the aorta. It results in increased pressure proximal to the defect and decreased pressure distal to it. The most common site of coarctation is just beyond the origin of the left subclavian artery from the aorta, resulting in high blood pressure in the upper extremities and head and low blood pressure in the lower extremities. ▪ OBSERVATIONS: Symptoms are directly related to the pressure changes created by the constriction. Clinical manifestations include dizziness, headaches, fainting, epistaxis, reduced or absent femoral pulses, and muscle cramps in the legs from tissue anoxia during increased exercise. Diagnosis is based on characteristic pressure changes in the upper and lower body and specific radiological and echocardiographic findings, including notching of the lower ribs, left ventricular hypertrophy, and dilation of the aorta proximal to the stricture. A murmur may or may not be present. ▪ INTERVENTIONS: Surgical repair is recommended for minor defects because of the high incidence of untreated complications, including aortic rupture, hypertension, infective endocarditis, subarachnoid hemorrhage, and congestive heart failure. ▪ PATIENT CARE CONSIDERATIONS: Early detection and treatment usually lead to a successful outcome. The health care team should recognize that careful follow-up is necessary.
