A 4 1/2- year-old girl always had to wear warm socks even is summer season. On physical examination, it was noticed that
she had high blood pressure and her femoral pulse was weak as compared to radial and carotid pulse, a chest radiograph
showed remarkable notching of ribs along with their lower borders. This was due to:
Cold extremities, high B.P. in upper extremity with marked diminution of pulsations and B.P. in the lower extremity is characteristic of Coarctation of Aorta. More facts about Coarctation of Aorta Most patients are asymptomatic.

Symptomatic patients usually present with following features. Headache dizziness

* Epistaxis* Cold extremities and weakness in legs * Claudication with exercise.
* Hypertension in upper extremities with marked diminution of pulsation in lower extremities.

Mid-systolic or continuous murmur over the anterior part of the chest and back.

* Enlarged and pulsatile collateral vessels in intercostal spaces anteriorly in the axilla or posteriorly in interscapular area.

Upper extremity is more developed than the lower extremity.

* Remember that the Cardiac output responds normally to exercise.
* Most common site* of Coarctation of Aorta is just distal to the origin of the left subclavian artery.

If it arises above the subclavian artery, blood pressure elevation is evident only in the right arm.
Bicuspid aortic valve* is the most common abnormality associated with coarctation of Aorta.

Radiography

notching of the inferior surface of ribs*
indentation of the aorta at the site of coarctation and ‘3’ sign* on the para mediastinal shadow.

Complications: 

cerebral aneurysm
left ventricular failure*
infective endocarditis
Coarctation of aorta
Femoral artery thrombosis
Raynaud’s disease
Takayasu’s arteritis