Headache, epistaxis, cold extremities, and claudication with exercise may occur Hea murmur or 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. ( Harrison&;s principle of internal medicine,18th edition,pg no. 1925)