A 27 year old man in noted to have blood pressure of 170/100 mmHg. He has prominent aoic ejection click and murmurs heard over the ribs on the both sides anteriorly and over the back posteriory. In addition, the pulses in the lower extremities are feeble and he complains of mild claudication with exeion. The most likely diagnosis is-
Correct Answer: Coarctation of the aoa
Description: Most children and young adults with isolated, discrete coarctation are asymptomatic. Headache, epistaxis, cold extremities, and claudication with exercise may occur, hypeension in the upper extremities and absence, marked diminution, or delayed pulsations in the femoral aeries are detected on physical examination. Enlarged and pulsatile collateral vessels may be palpated in the intercostal spaces anteriorly, in the axillae, or posteriorly in the interscapular area. The upper extremities and thorax may be more developed than the lower extremities. A midsystolic murmur over the left interscapular space may become continuous if the lumen is narrowed sufficiently to result in a highvelocity jet across the lesion throughout the cardiac cycle. Additional systolic and continuous murmurs over the lateral thoracic wall may reflect increased flow through dilated and touous collateral vessels. The ECG usually reveals LV hyperophy. ( Harrison&;s principle of internal medicine,18th edition,pg no. 1925 )
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