From the Guidelines
Coarctation of the aorta is typically associated with a murmur or bruit heard in the left interscapular position on heart auscultation, which may be due to the coarctation itself or the presence of collateral vessels. The physical exam findings for coarctation of the aorta include a pulse delay between the right arm and the femoral or popliteal arteries, and auscultation should be directed toward detecting a parasternal and apical systolic ejection sound suggestive of an associated bicuspid aortic valve (BAV) with or without a systolic crescendo-decrescendo murmur of left ventricular outflow tract (LVOT) obstruction or an early diastolic decrescendo murmur of aortic regurgitation (AR) 1. Some key points to consider when examining a patient with coarctation of the aorta include:
- Hypertension in the right arm relative to the lower extremities
- Hyperdynamic carotid pulsations
- Presence of collateral vessels, which may produce continuous murmurs over the parasternal areas or around the left scapula
- Palpable periscapular collaterals in some cases These findings are crucial for the diagnosis and management of coarctation of the aorta, and a thorough auscultation is essential to detect the characteristic murmurs and bruits associated with this condition 1.
From the Research
Physical Exam Findings on Heart Auscultation
- A systolic murmur over the anterior chest is a common finding in patients with coarctation of the aorta 2
- Bruits over the back may also be present 2
Associated Signs
- Diminished and delayed pulses in the right femoral artery compared with the right radial or brachial artery are an important clue to the presence of a coarctation of the aorta 2
- Visible notching of the posterior ribs on a chest x-ray may also be observed 2
Diagnostic Confirmation
- Two-dimensional echocardiography with Doppler interrogation is used to confirm the diagnosis of coarctation of the aorta 2