Hi, my name is Tom and in this episode we're going to be talking about co-archation of the aorta.

And you can find notes at zero to finals.com and in the zero to finals pediatrics book

and questions and flashcards to train your knowledge at members.0.0.0.com. And if you stick around to

the end of the episode, we'll go through some questions on co-actation to test your knowledge and what

you've just heard. So let's get straight into it. Co-arcation of the aorta involves a narrow

point in the aortic arch, usually near the ductus arteriosis.

The severity varies from mild to severe. It may be associated with a genetic condition, particularly

Turner's syndrome. There is an increased pressure, proximal or before the narrowing and a decreased pressure distal or beyond

the narrowing.

Let's go through the presentation.

The only indication in a neonate that they have co-actation of their altar may be weak femoral pulses,

and this is part of the routine newborn baby check to try and pick up the condition.

Blood pressure readings from all four limbs will show an increased pressure

in the limbs supplied by vessels that are proximal or come before the

narrowing, for example in the arms, and a reduced blood pressure in the limbs that are supplied

by vessels distal to the narrowing, for example in the legs. Co-arctation can produce a systolic

murmur which is heard inferior or just below the left clavicle and the left scapula.

Other signs in infancy, depending on the severity, are a raised respiratory rate, increased work of breathing, poor feeding, heart failure, and shock.

Additional signs may develop over time, including a left ventricular heave due to left

ventricular hypertrophy, where the left ventricle becomes thickened and bulky due to the increased work of pushing

blood past this narrowing, an underdeveloped left arm where there's reduced flow to the left

subcalavian artery, and underdevelopment of the legs. Finally, let's go through management. Management depends on the severity.

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