Provider:

i. Questions for HPI

When did these symptoms begin?

Is the child experience exercise intolerance?

Any shortness of breath/signs of respiratory distress?

History of genetic conditions?

ii. Questions for ROS

Poor feeding?

Any newborn cardiac concerns?

Previous cardiac history?

Any pain, weakness, coldness to the extremities?

Fluid retention?

Cough when laying down?

iii. Physical Exam – what will you assess

Heart murmur – murmur of mitral regurgitation

Diminished or delayed femoral pulses – brachiofemoral delay

Vitals – upper extremity hypertension

iv. Vital Signs/Diagnostic testing

Echocardiogram – demonstrate a narrowing in the aortic arch

EKG – left ventricular hypertrophy

Vital signs – strong pulses and hypertension in the upper extremities, diminished or delayed femoral pulses, and a blood pressure (BP) gradient, with low or unobtainable arterial BP in the lower extremities

v. Diagnosis and 2 Differentials

Diagnosis

Coarctation of the aorta Q25. 1

Differential Diagnosis

Aortic dissection I71. 0

Pediatric hypoplastic left heart syndrome Q23. 4

Peripheral arterial occlusive disease I73. 9

vi. Treatment Plan/Education

Refer to pediatric cardiology

Moderate cases with symptoms – cardiac catheterization may be used to widen the aorta, either catheter balloon which is inflated to stretch the aorta or a stent

Any surgical intervention is not a direct cure – this will requre regular check-ups to monitor progress and anticipate any follow-up treatment.

(Doshi & Chikkabyrappa, 2018); (Law & Tivakaran, 2023)

References

Doshi, A. R., & Chikkabyrappa, S. (2018). Coarctation of aorta in children. Cureus, 10(12), e3690.

Law, M. A., & Tivakaran, V. S. (2023). Coarctation of the aorta. In StatPearls. StatPearls Publishing.