David is a 7yearold requiring a routine physical examination

David is a 7-year-old requiring a routine physical examination at the nurse practitioner\'s office. David\'s past medical and family history is not unusual. His activity level is normal, and his mother verbalizes that he is quite healthy. David\'s physical examination is normal until the cardiovascular system is evaluated. He is noted to have a systolic murmur. There are also bounding pulses in the arms and severely decreased pulses in the legs. A pediatric cardiology con­sultation is requested.

Which cardiac defect causes such a striking discrepancy in blood flow to the upper and lower extremities? Explain.

Solution

David has Coarctation of the aorta (CoA) which is a congenital malformation of the aorta.Coarctation of the aorta causes a striking discrepancy in blood flow to the upper and lower extremities.Child with a coarctation has higher blood pressure in the arms than in the legs. The doctor also might hear a heart murmur or notice that the pulse in the groin is weak or hard to feel. The aorta is the largest artery in body which leaves the left ventricle of the heart and runs through the middle of body, through the chest and into the abdominal area. It then branches out to deliver freshly oxygenated blood to lower limbs. A constriction or narrowing of this important artery can result in a decreased flow of oxygen.The constricted part of the aorta is generally near the top of the heart, where the aorta exits the heart.As the heart tries to pump oxygen-rich blood to the body, the blood has trouble getting through it. This causes high blood pressure in the upper parts of body and reduced blood flow to the lower parts of body.