Provider:
i. Questions for HPI
When did these symptoms begin?
Is the child experience exercise intolerance?
Any shortness of breath/signs of respiratory distress?
History of genetic conditions?
ii. Questions for ROS
Poor feeding?
Any newborn cardiac concerns?
Previous cardiac history?
Any pain, weakness, coldness to the extremities?
Fluid retention?
Cough when laying down?
iii. Physical Exam – what will you assess
Heart murmur – murmur of mitral regurgitation
Diminished or delayed femoral pulses – brachiofemoral delay
Vitals – upper extremity hypertension
iv. Vital Signs/Diagnostic testing
Echocardiogram – demonstrate a narrowing in the aortic arch
EKG – left ventricular hypertrophy
Vital signs – strong pulses and hypertension in the upper extremities, diminished or delayed femoral pulses, and a blood pressure (BP) gradient, with low or unobtainable arterial BP in the lower extremities
v. Diagnosis and 2 Differentials
Diagnosis
Coarctation of the aorta Q25. 1
Differential Diagnosis
Aortic dissection I71. 0
Pediatric hypoplastic left heart syndrome Q23. 4
Peripheral arterial occlusive disease I73. 9
vi. Treatment Plan/Education
Refer to pediatric cardiology
Moderate cases with symptoms – cardiac catheterization may be used to widen the aorta, either catheter balloon which is inflated to stretch the aorta or a stent
Any surgical intervention is not a direct cure – this will requre regular check-ups to monitor progress and anticipate any follow-up treatment.
(Doshi & Chikkabyrappa, 2018); (Law & Tivakaran, 2023)
References
Doshi, A. R., & Chikkabyrappa, S. (2018). Coarctation of aorta in children. Cureus, 10(12), e3690.
Law, M. A., & Tivakaran, V. S. (2023). Coarctation of the aorta. In StatPearls. StatPearls Publishing.
