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coarctation of aorta

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Tatsuki Abe

on 23 October 2013

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Transcript of coarctation of aorta

Mr. A, a 30 yearold previously healthy man from Bangladesh is sent to your clinic for a compulsury medical check-up as a prerequisite for him to work in Malaysia.
Clinical Scenario
He is currently well, but is unable to tell sufficient history due to his inability to speak english or bahasa, nor we don't have the ability to speak Bangladeshy.
physical examination
Vital Signs ;
BP - 150/75 on right bracheal artery, patient lying 45deg. propped up upon rest.
Pulse rate 75 bpm, regular, fair volume - no radial-radial delay.
not tachypnec
PaO2 - 100%

generally patient well and cooperative, not in obvious pain. GCS full, hydration fair.
now you start to wonder, what can he be having, for him to have this various physical findings without symptoms?
because you're a GOOD physician, you proceed to check his health status top to toe.... and you notice some strange things.
oral hygene is fair, with few caries.
eyes are normal, no jaundice no pallor. no ptosis / proptosis etc
there is a previously corrected cleft-lip scar
some impacted ear-wax on the left ear
carotid pulse palpated normally bilaterally
chest is of normal size and shape.
no aortic bruit
upon auscultation, an ejection-systolic murmur is heard which is radiating to the axilla as well as carotids. it is accentuated when leaning forward.
femoral pulse was very difficult to palpate (which is weird, because you usually have no problem), so you decided to skip and come back later.
genitalia is normal.
you notice the foot is cold, and dry.
you also notice numerous scars which seemed to show poor healing.
your attempt to feel the lower extremity pulses have failed.
what examinations would you like to perform?
what investigations would you like to order?
normal X-ray for reference
radio-femoral delay was attempted to be taken - femoral pulse was diminished.
there is a soft murmur heard at the infra-clavicular region.
there is a systolic murmur heard at between the scapula, as well as under left scapula.
chest X-ray of Mr. A
Notching of the posterior one-third of the third to eighth ribs
characteristic 3 sign consisting of the enlarged and distorted aortic knob and subclavian artery forming the upper portion of the 3, the waist at the site of the coarctation (arrow), and the lower portion formed by the post stenotic dilatation of the proximal descending aorta.
...what do we have here?
comparing back the palm and the soles of the feet, the feet are definitely more pale compared to the palm, and the coldness of the feet is noted even more clearly.
Full transcript