Coarctation of the Aorta - Diagnosis — EECC MCQ

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ModerateCongenital Heart Disease (Adult)Coarctation of the Aorta - DiagnosisEECC

A 28-year-old man presents with hypertension (BP 185/105 mmHg in both arms), headache, and leg claudication. Femoral pulses are weak and delayed compared with the radial pulse. What investigation is most appropriate to confirm the suspected diagnosis?

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Correct answer: D — MRI or CT aortography to assess the site and severity of aortic coarctation

The clinical features (upper limb hypertension, weak/delayed femoral pulses — radial-femoral delay, leg claudication in a young person) are classic for coarctation of the aorta. While echocardiography can identify the coarctation and assess LV function and associated bicuspid aortic valve, cross-sectional imaging with MRI (preferred — no radiation) or CT aortography is required to define the anatomy: site and severity of narrowing, collateral circulation, and associated aortic arch hypoplasia. This information is essential for planning intervention (percutaneous stenting or surgical repair). The 2020 ESC ACHD Guidelines recommend intervention when the peak-to-peak gradient is >20 mmHg, or when there is hypertension with radiological evidence of significant coarctation.

Reference: ESC (2020): Guidelines for the Management of Adult Congenital Heart Disease