new_n_lost
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| | 12/18/07 - 05:23 PM
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A 25-year-old man presents with headache, dizziness, and claudication. Blood pressure measurements reveal hypertension in the upper limbs and hypotension in the lower limbs.
Which of the following additional findings would be most likely in this case?
A. Aortic valvular stenosis
B. Notching of inferior margins of ribs
C. Patent ductus arteriosus
D. Pulmonary valvular stenosis
E. Vasculitis involving the aortic arch
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| Aashi
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Classic pic of CoA------> Notching of inferior margins of ribs ------>B
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| silver
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B
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| new_n_lost
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Aashi wrote:
Classic pic of CoA------> Notching of inferior margins of ribs ------>B
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| new_n_lost
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The correct answer is B.
The adult form of aortic coarctation is caused by stenosis in the aortic arch just distal to the left subclavian artery. This leads to hypertension proximal to, and hypotension distal to, the stenotic segment. Hypertension in the upper part of the body manifests with headache, dizziness, and other neurologic symptoms. Hypotension in the lower part of the body results in signs and symptoms of ischemia, most often claudication, i.e., recurrent pain due to ischemia of leg muscles. In addition, collateral arteries between the precoarctation and postcoarctation aorta (eg, the intercostal and internal mammary arteries) enlarge and establish communication between aortic segments proximal and distal to stenosis. Enlarged intercostal arteries produce notching of the inferior margins of the ribs, which can be detected on x-ray and is diagnostic of this condition. Remember that the infantile form of aortic coarctation is associated with patent ductus arteriosus, whereas the adult form is not.
Aortic valvular stenosis (choice A) at this age would most likely be caused by a congenitally malformed valve, usually a valve with two cusps or a single cusp. Aortic stenosis manifests with systolic hypotension, recurrent syncope, and hypertrophy/dilatation of the left ventricle. Low systolic pressure is present in the entire body.
The isolated form of patent ductus arteriosus (choice C) leads to shunting of blood from the aorta (high-pressure vessel) to the pulmonary artery (low-pressure vessel). Eventually, chronic cor pulmonale develops with resultant right-sided heart failure.
Pulmonary valvular stenosis (choice D) is a rare form of congenital heart disease that leads to chronic cor pulmonale and heart failure.
Vasculitis involving the aortic arch (choice E) is found in Takayasu arteritis, in which chronic inflammatory changes develop in the aortic arch and its branches (brachiocephalic trunk, left common carotid, and left subclavian arteries). This condition causes stenosis of these arteries; therefore, there will be signs and symptoms of ischemia to the upper part of the body. Since the radial pulses are very weak or absent, this disorder is also known as pulseless disease.
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FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
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