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Coarctation of the aorta in a 6 month old
International Journal of Emergency Medicine volume 3, pages527–528 (2010)
A 6-month-old male presented with increased respiratory efforts, a low grade fever, O2 saturations in the high 80s and wheezing. Symptoms improved with nebulized albuterol. A chest X-ray revealed cardiomegaly and a right-sided infiltrate (Figs. 1 and 2); EKG revealed criteria consistent with left ventricular hypertrophy (LVH). An echocardiogram confirmed coarctation of the aorta (Fig. 3).
Coarctation of the aorta is a narrowing of the lumen of the aortic arch classified as either “pre-ductal” or “post-ductal” based on the location relative to the origin of the left subclavian artery [1–3]. In 85% of cases, coarctation of the aorta is seen with other congenital defects . Males are twice as likely to have coarctation of the aorta, although it is a common manifestation of Turner’s syndrome [1, 3].
The condition can also be sub-divided into infantile (within the first year of life) and non-infantile (delayed) presentation. When the ductus arteriosus closes shortly after birth, infants with coarctation can present with cardiovascular collapse and resulting cyanosis . In the non-infantile presentation, collateralization of blood vessels (including intercostal, subclavian, vertebral, anterior spinal, and internal mammary arteries) allows for the distal aorta to be adequately perfused [1, 3]. In the non-infantile presentation, upper extremity systolic hypertension, a short systolic murmur in the left interscalpular area, and diminished/absent femoral pulses can be seen in otherwise asymptomatic patients . Older children and adults present symptomatically with dyspnea, headache, and/or leg fatigue [1, 3]. Our patient presented early because a para-influenza pneumonia stressed his cardiopulmonary system, caused wheezing, and led a prudent physician to obtain a chest X-ray in this “first-time wheezer.”
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Ferencz C, Rubin JD, Loffredo CA et al (1993) Epidemiology of congenital heart disease: the Baltimore-Washington Infant Study 1981–1989. In: Anderson RH (ed) Perspectives in pediatric cardiology, vol 4. Futura, Mount Kisco, NY, p 353
Crawford M (2009) Coarctation of the aorta. In: Current diagnosis and treatment cardiology, 3rd edn. McGraw-Hill, NY
Research was performed at the SUNY Upstate Medical Center Department of Emergency Medicine.
Conflict of interest