1 Department of Clinical Medicine, Health, Aarhus University2 Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.3 The Department of Cardiological Medicine B, Faculty of Health Sciences, Aarhus University, Aarhus University4 Department of Clinical Medicine - Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Health, Aarhus University5 Department of Clinical Medicine, Health, Aarhus University6 Department of Clinical Medicine - Center of Functionally Integrative Neuroscience, Department of Clinical Medicine, Health, Aarhus University
The present case shows that a normal brachial blood pressure (BP) does not exclude severe coarctation and should be considered in normotensive patients presenting with a systolic murmur and/or unexplained severe left ventricular hypertrophy. Congenital coarctation of the aorta is a narrowing of the descending aorta, usually located distal to the origin of the subclavian artery, causing hypertension in the upper part of the body. This condition may be undiagnosed until adult life where the clinical presentation most often is high BP in the upper extremities. A 57-year-old patient with severe aortic coarctation and left ventricular hypertrophy presented with normal brachial BP. However, standard suprasternal view by echocardiography indicated coarctation. Multislice computed tomographic (CT) angiography revealed an uncommon location of the aortic narrowing with the right and left subclavian arteries originating below the area of coarctation, explaining the equally low BP in both upper extremities.