View source for Coarctation of the aorta

==Background==
[[File:Blausen 0243 CoarctationofAorta CloseUp.png|thumb|Coarctation of the aorta.]]
[[File:Coarctation.jpg|thumb|Coarctation of the aorta.]]
*Narrowing of aorta, most commonly at ductus arteriosus insertion site just distal to left subclavian artery
**Less common: diffuse arch hypoplasia with long segment of narrowing proximal to left subclavian<ref>https://newbp.bmj.com/topics/en-gb/698</ref>
*~7% of live births with congenital heart disease <ref> Rosenthal E. Coarctation of the aorta form fetus to adult: curable condition or life long disease process? Heart Nov 2005; 91(11): 1495-1502</ref>
*Associated with bicuspid aortic valve (50%), [[VSD]], [[PDA]]

==Clinical Features==
*Systolic [[murmur]], often conducted to back
*Weak or absent femoral pulses, leg claudication, exercise intolerance
*Upper limb [[hypertension]]
*Usually diagnosed within first year of life, when presentation typically dramatic, particularly after closure of [[PDA]] in ductal-dependant critical coarctations. 
**Consider in all critically ill neonates, particularly with poor perfusion to lower extremities
**[[Heart failure]], [[shock]]
*Less severe coarctations may go undiagnosed for years, but can still lead to complications long-term<ref>https://pedemmorsels.com/coarctation-of-the-aorta-in-older-children/</ref>:
**[[Dysrhythmias]]
**[[Heart failure]]
**[[ICH]]
**[[Aortic dissection]]
**Infective [[endocarditis]]

==Differential Diagnosis==
{{Sick neonate DDX}}

==Evaluation==
[[File:Coarctation CXR.jpg|thumb|Chest x-ray showing classic findings for coarctation of the aorta.]]
[[File:1440px-Co.A. 01- 4 M Kind - Z. n. End-zu-End.jpg|thumb|Coarctation of the aorta on cath.]]
*[[CXR]]
**Rib notching due to collateral blood vessels
**"Figure 3" sign seen in 50% of patients
**Abnormal aortic knob shadow due to coarct and dilation of left subclavian
*[[EKG]]: LVH +/- LA enlargement
*[[Echocardiography]]
*Cardiac MRI

==Management==
===Neonate in Shock (duct-dependent lesion)===
*[[PGE1]] 0.1mcg/kg/min IV/IO 
**Side Effects: 
***Apnea (intubate) 
****[[Hypotension]]
****Bradycardia 
****Flushing 
*[[NS]] 10cc/kg 
*[[Dobutamine]]

===[[CHF]]===
*[[O2]] (give only if SpO2 <95%) 
*[[Furosemide]] 1-2mg/kg IV 
*[[Dopamine]] 5-10mcg/kg/min 
*[[Dobutamine]] 5-10mcg/kg/min

==Disposition==
*Admit

==Medication Dosing==
{{MedicationDose
| drug = Prostaglandin E1
| dose = 0.1mcg/kg/min IV/IO
| route = IV/IO
| context = Duct-dependent lesion, maintain PDA patency
| indication = Coarctation of the aorta
| population = Pediatric
}}
{{MedicationDose
| drug = Furosemide
| dose = 1-2mg/kg IV
| route = IV
| context = CHF management
| indication = Coarctation of the aorta
| population = Pediatric
}}
{{MedicationDose
| drug = Dopamine
| dose = 5-10mcg/kg/min IV
| route = IV
| context = Inotropic support for CHF
| indication = Coarctation of the aorta
| population = Pediatric
}}
{{MedicationDose
| drug = Dobutamine
| dose = 5-10mcg/kg/min IV
| route = IV
| context = Inotropic support for CHF
| indication = Coarctation of the aorta
| population = Pediatric
}}

==See Also==
*[[Congenital heart disease]]
*[[Neonatal resuscitation]]

==External Links==
*[https://www.acep.org/how-we-serve/sections/pediatric-emergency-medicine/pedemmorsels/coarctation-of-the-aorta-in-the-older-child/ ACEP - Coarctation of the Aorta in the Older Child]

==References==
<references/>
[[Category:Pediatrics]] [[Category:Cardiology]]