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Coarctation of the Aorta — RACP Adult Medicine MCQ

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ModerateCardiologyCoarctation of the AortaRACP Adult Medicine

A 22-year-old man presents with hypertension (BP 175/100 mmHg in the right arm, 140/85 mmHg in the left arm). BP in both legs is 110/80 mmHg. He has radio-femoral delay and a continuous murmur over the back between the scapulae. CXR shows rib notching. Echo shows a bicuspid aortic valve. What is the most likely diagnosis?

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Correct answer: D — Coarctation of the aorta

Upper limb hypertension with lower limb hypotension (gradient >20 mmHg), radio-femoral delay, posterior continuous murmur (from collateral vessels), rib notching on CXR (from dilated intercostal arteries), and associated bicuspid aortic valve (present in ~50% of coarctation) is aortic coarctation. Treatment: catheter-based stenting or surgical repair. Lifelong surveillance for re-coarctation and associated aortic disease.

Reference: ESC – 2024 – ACHD Guidelines; CSANZ 2024