Re-coarctation of the Aorta — EECC MCQ

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ModerateCongenital Heart Disease (Adult)Re-coarctation of the AortaEECC

A 35-year-old woman with a repaired coarctation of the aorta (end-to-end anastomosis at age 5) presents with headaches and upper limb hypertension (BP 165/95 mmHg right arm) but normal lower limb BP (128/82 mmHg). What is the most likely cause?

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Correct answer: D — Re-coarctation at the repair site

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · B = shown as D · A = shown as E

Upper limb hypertension with a significant arm-leg BP gradient (above 20 mmHg systolic) in a patient with prior coarctation repair is highly suggestive of re-coarctation. Essential hypertension (A) would not produce an arm-leg gradient. Aortic dissection (C) would present acutely. White-coat hypertension (D) would not cause a gradient. Phaeochromocytoma (E) causes episodic hypertension without arm-leg gradient.

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