Open Access

Coarctation of the aorta in a 6 month old

International Journal of Emergency Medicine20103:251

https://doi.org/10.1007/s12245-010-0251-3

Received: 6 October 2010

Accepted: 20 October 2010

Published: 8 December 2010

A 6-month-old male presented with increased respiratory efforts, a low grade fever, O2 saturations in the high 80s and wheezing. Symptoms improved with nebulized albuterol. A chest X-ray revealed cardiomegaly and a right-sided infiltrate (Figs. 1 and 2); EKG revealed criteria consistent with left ventricular hypertrophy (LVH). An echocardiogram confirmed coarctation of the aorta (Fig. 3).
Fig. 1

Anteroposterior chest X-ray showing cardiomegaly and para-influenza pneumonia

Fig. 2

Lateral chest X-ray showing cardiomegaly

Fig. 3

EKG showing LVH consistent with cardiomegaly

Coarctation of the aorta is a narrowing of the lumen of the aortic arch classified as either “pre-ductal” or “post-ductal” based on the location relative to the origin of the left subclavian artery [13]. In 85% of cases, coarctation of the aorta is seen with other congenital defects [1]. Males are twice as likely to have coarctation of the aorta, although it is a common manifestation of Turner’s syndrome [1, 3].

The condition can also be sub-divided into infantile (within the first year of life) and non-infantile (delayed) presentation. When the ductus arteriosus closes shortly after birth, infants with coarctation can present with cardiovascular collapse and resulting cyanosis [1]. In the non-infantile presentation, collateralization of blood vessels (including intercostal, subclavian, vertebral, anterior spinal, and internal mammary arteries) allows for the distal aorta to be adequately perfused [1, 3]. In the non-infantile presentation, upper extremity systolic hypertension, a short systolic murmur in the left interscalpular area, and diminished/absent femoral pulses can be seen in otherwise asymptomatic patients [1]. Older children and adults present symptomatically with dyspnea, headache, and/or leg fatigue [1, 3]. Our patient presented early because a para-influenza pneumonia stressed his cardiopulmonary system, caused wheezing, and led a prudent physician to obtain a chest X-ray in this “first-time wheezer.”

Declarations

Acknowledgments

Research was performed at the SUNY Upstate Medical Center Department of Emergency Medicine.

Conflict of interest

None.

Authors’ Affiliations

(1)
Department of Emergency Medicine, Upstate Medical University

References

  1. Brickner E (2007) Congenetal heart defects. In: Textbook of cardiovascular medicine, 3rd edn. Lippincott Williams & Wilkins, PhilidelphiaGoogle Scholar
  2. Ferencz C, Rubin JD, Loffredo CA et al (1993) Epidemiology of congenital heart disease: the Baltimore-Washington Infant Study 1981–1989. In: Anderson RH (ed) Perspectives in pediatric cardiology, vol 4. Futura, Mount Kisco, NY, p 353Google Scholar
  3. Crawford M (2009) Coarctation of the aorta. In: Current diagnosis and treatment cardiology, 3rd edn. McGraw-Hill, NYGoogle Scholar

Copyright

© The Author(s) 2010

This article is published under license to BioMed Central Ltd. Open Access This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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