Clinical features:
(1) arterial hypertension in the upper extremities with an arterial blood pressure in the lower extremities that is the same or lower (normally the systolic blood pressure is 5-10 mm Hg higher in the lower extremities)
(2) delay in the pulse between the brachial and femoral arteries
(3) lower amplitude in the femoral compared to the brachial artery
(4) parascapular systolic or continuous murmur over the left upper back
Variations:
(1) delay in pulse between the right and left brachial arteries (if either the left subclavian artery is involved by the coarctation or the right subclavian artery arises beyond the left subclavian artery)
(2) ejection sound at the apex and a midsystolic murmur at the base (if a bicuspid aortic valve is present)
(3) cyanosis of the lower limbs only
(4) discrepancy in limb development with right upper limb normal and the lower limbs underdeveloped (the left upper limb may be underdeveloped if the vascular supply is compromised)
Imaging findings in the chest X-ray:
(1) notching along the inferior margins of the ribs (due to collateral flow around the coarctation)
(2) "3" sign (formed by a dilated left subclavian artery above the coarctation and a convex dilated descending aorta below
Associated cardiovascular anomalies are common and may include:
(1) bicuspid aortic valve
(2) ventricular septal defect
(3) aortic stenosis and/or insufficiency
(4) transposition of the great vessels
(5) atrioseptal defect
(6) truncus arteriosus
(7) double outlet right ventricle
(8) tubular hypoplasia of the aortic arch
Complications may include:
(1) congestive heart failure
(2) rupture of the aorta
(3) endocarditis
(4) intracranial hemorrhage
