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 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. ( Harrison&;s principle of internal medicine,18th edition,pg no. 1925) 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.