Let's move on to the next type of obstructive heart disease,
which is coarctation of the aorta.
As you can see on the slide here,
this patient has a normal aortic arch that's coming along,
and then there's a pinched area right where the green highlight is.
This is a narrowing of the aorta,
or a coarctation of the aorta, after it leaves the ventricle.
As you imagine, this pressure builds up before this narrowing
and they develop left ventricular hyperthrophy.
Likewise, this results in hypertension.
And in fact, this is the only congenital heart disease
that will present with hypertension.
Remember, the kidneys are governing your body's blood pressure.
These kidneys are experiencing a lower pressure because of that coarctation.
They're ramping up the angiotensin system.
As a result, this child may will have systemic hypertension.
Femoral pulses are often how we pick up this problem.
An infant with coarctation of the aorta is going to have weak or absent femoral pulses.
One of my colleagues picked up a patient with bronchiolitis,
a normal developing baby, and noticed those weak pulses.
It's important to feel those femoral pulses.
It takes practice though.
Don't be frustrated, keep trying, and get better at it.
Coarctation of the aorta can present in really two major ways,
and I'm gonna walk through this carefully.
One is the critical coarct, which is what's presenting in the newborn period -- these babies are very, very sick.
Or a patient can have a mild coarct, which can present much later or even in adulthood.
In a critical coarct of the newborn,
these patients will present with heart failure and shock.
They can't get the blood out to the body in a significant enough pressure,
so they're getting end-organ damage.
In these patients, we will treat with prostaglandins
to keep that patent ductus arteriosus open,
and we will enact a surgical repair of the coarct right at birth.
But many children get through the newborn period
and nobody notices a problem.
Coarctation of the aorta can be very subtle.
Again, it may present just with abnormal femoral pulses.
In these cases, it will present even in adulthood.
These patients will start developing fatigue.
They may have poor growth as they go through childhood.
You may hear a systolic murmur,
that turbulent flow as the blood flows to that narrowed area of the aorta.
Again, those poor femoral pulses,
and again you'll notice that hypertension.
One common finding in patients with coarctation of the aorta is the rib notching.
What basically happen is that because of the low pressue of the descending aorta,
a pressure gradient is created between the internal thoracic artery and the descending aorta.
Because the blood pressue in the internal thoracic artery is higher than the descending aorta,
an increase collateral circulation takes place through the intercostal arteries,
this can lead the appearance of rib notching in the chest x-rays,
where the lower surface of the rib appear eroded.