Adolescent Systemic Hypertension: Late Diagnosis of Coarctation of the Aorta

Abstract

The morbidity and mortality rates are low for patients undergoing treatment, for both surgical or catheter interventions, though long-term follow-up is required for complications. Today the diagnosis is often made prenatally with the advent of fetal echocardiography; however, approximately 30% of neonates with coarctation remain undiagnosed upon discharge after delivery. This cardiac defect generally results in left ventricular pressure overload and the patient presentation often varies with the severity of the left ventricular outflow tract obstruction. Additionally, coarctation may be associated with other cardiac defects, as well as chromosomal abnormalities such as Turner syndrome. Case Description A 14-year-old boy was referred to our community pediatric cardiology outpatient clinic for an incidental finding of systemic hypertension that was noted by the patient’s family physician on routine evaluation. The patient was completely asymptomatic, with no visual changes, no headaches, and had a normal activity profile by history. He had an unremarkable past medical history and also had a family history of late-onset hypertension. Abstract Coarctation of the aorta accounts for 5–7% of all the cases of congenital heart disease, with an estimated incidence of approximately 3 cases per 10,000 births. Coarctation of the aorta typically presents in the neonatal or early childhood period. The less severe coarctation patients may have subtle clinical findings such as elevated upper limb blood pressure, diminished femoral pulses, and a systolic ejection murmur that often transmits to the back. This case demonstrates that coarctation can be seen in the otherwise healthy adolescent population.