Unveiling Coarctation: A Case of Early Onset Hypertension Unravelling a Late Diagnosis of an Aortic Defect
DOI:
https://doi.org/10.35516/jmj.v60i1.3918الكلمات المفتاحية:
Aortic stenosis، bicuspid aortic valve، hypertensionالملخص
Background: Coarctation of the aorta (CoA) is a congenital heart defect occurring in approximately 6–8% of live births with congenital heart diseases. It is characterised by narrowing of the aorta, and although often diagnosed during infancy or childhood due to its impact on blood pressure (BP) regulation, some cases may not be identified until adolescence.
Case: We report a case of a 25-year-old male who presented to the ER with non-exertional chest pain, palpitations, and facial plethora. He has a history of undiagnosed hypertension, an average BP of 150/90, a significant BP gradient between upper and lower limbs (>40 mmHg), and radio-femoral delay on physical examination.
Decision-making: Comprehensive tests were conducted; results included a negative troponin assay, an electrocardiogram (ECG) showing normal sinus rhythm with left ventricular hypertrophy (LVH) and a left bundle branch block (LBBB), an echocardiogram revealing a bicuspid aortic valve (BAV) and severe concentric hypertrophy of 1.7 cm with a low-normal ejection fraction, and a normal chest X-ray. Subsequently, a computed tomography angiography confirmed the diagnosis of severe CoA with extensive collaterals, which warranted catheterization. A covered Cheatham Platinum stent was implanted, and the patient was discharged on appropriate medications afterwards.
Conclusion: This rare case of a BAV with CoA presenting in adulthood underscores the significance of timely detection, intervention, and long-term management. The late onset of symptoms is noteworthy, with the extensive collateral circulation accounting for it. Further follow-up is essential to monitor his chest pain and hypertension.
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