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Clinical data: The patient reported that, at the age of 23 years, he had been diagnosed with hypertension, which was controlled with five antihypertensive medications. An ultrasound study performed one month ago detected low blood flow through the abdominal aorta. Coarctation of the aorta was suspected, and further confirmed by angiographic CT scan. He had no cardiovascular complaints, but had a sedentary lifestyle.  Physical examination: normal breathing; acyanotic; brisk pulses in upper limbs, absent in lower limbs. Weight: 77 kg; height: 168 cm; Blood pressure - BP = right arm = left arm = 125/75 mmHg; BP legs = 75 mmHg; heart rate - HR: 86 bpm. Aorta clearly palpable on the suprasternal notch. Mild grade 1/4 systolic murmur on the suprasternal notch.  Apical impulse not palpable in the precordium; absence of systolic impulses on the left sternal border. Normal heart sounds; grade 1/4 coarse systolic murmur in the aortic area, with no irradiation. No murmurs in the back. Liver not palpable.

Case 4/2015 A 48-year-old Male Patient with Coarctation of the Aorta, Bicuspid Aortic Valve and Normal Ascending Aorta