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Post-coarctation hypertension — RACP Paediatrics MCQ

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HardNephrologyPost-coarctation hypertensionRACP Paediatrics

A neonate with coarctation of the aorta (post-repair) develops severe hypertension on day 3 post-op (BP 130/85 mmHg by arterial line). There is abdominal distension. What is the most appropriate IV antihypertensive, and what complication should be considered?

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Correct answer: D — IV hydralazine

Post-coarctation repair paradoxical hypertension can cause mesenteric arteritis (abdominal pain, bloody stools). IV hydralazine or IV labetalol are commonly used for post-operative hypertension. IV esmolol (ultra-short-acting beta-blocker) is another option. Careful BP control is essential to prevent post-coarctectomy syndrome. Abdominal distension suggests mesenteric arteritis requiring bowel rest.

Reference: RACP Paediatric Curriculum – Cardiology/Nephrology; RCH Melbourne – 2023