Pediatrics · Topic 25 of 42
Coarctation of the Aorta
Start here
Tap any line to see why it matters
Coarctation of the Aorta
A narrowing of the aorta just past the left subclavian artery: pressure runs high in the arms and low in the legs. A newborn with critical coarctation crashes as the ductus closes.
Why it happens
The aorta narrows just past the left subclavian artery
Coarctation makes up about 6–8% of congenital heart defects and is about twice as common in males.
Linked conditions
Think coarctation with Turner syndrome or a bicuspid aortic valve
Coarctation occurs in about 10–20% of clients with Turner syndrome; a bicuspid aortic valve is found in about 45–62% of clients with coarctation.
What you'll see
Arms high, legs low — the newborn can crash, the older child can look well
Older children may have no symptoms at all. Murmur: systolic ejection at the upper left sternal border, often loudest over the back between the shoulder blades. Rib notching on chest X-ray (enlarged collateral arteries) is seldom seen before age 5.
Assessment & numbers
Take BP in all four extremities
In newborns, single limb readings vary widely; an isolated 20 mmHg difference may be measurement noise, and echocardiography confirms or excludes coarctation.
Red flags
Rarer after repair, report: abdominal pain with high BP (mesenteric arteritis, postcoarctectomy syndrome), leg paralysis (spinal cord ischemia — check leg movement), hoarseness (recurrent laryngeal nerve injury).
Treatment
Give immediately for critical coarctation
Apnea, usually within the first hourResection with end-to-end anastomosis
Balloon angioplasty, often with a stent
Check BP often; give IV antihypertensives as ordered
Check femoral and pedal pulses tooHeart failure care and long-term numbers
Nursing priorities
Teach the family
No routine antibiotics before dental work for unrepaired coarctation; after repair with prosthetic material or a stent, prophylaxis is given only for the first 6 months.
Arms high, legs low — take BP in all four extremities and compare brachial with femoral pulses. A newborn who crashes as the ductus closes needs prostaglandin E1 now. After repair, expect rebound hypertension.
Sources · Coarctation of the Aorta (Merck Manual Professional) · Coarctation of the aorta (MedlinePlus) · Coarctation of Aorta in Children (Cureus, PMC) · Prostin VR Pediatric (alprostadil) label (DailyMed) · Abdominal pain after stenting for aortic coarctation (J Vasc Surg Cases, PMC) · Variability of four limb blood pressure in normal neonates (Arch Dis Child, PMC) · Oscillometric blood pressures in healthy children and aortic coarctation (Pediatrics) · Antibiotic Prophylaxis Prior to Dental Procedures (ADA) · Follow your facility's protocol for alprostadil.
Coarctation of the Aorta
Coarctation of the aorta is a narrowing of the aorta, usually just past the left subclavian artery where the ductus arteriosus joins it, that makes blood pressure run high in the arms and low in the legs. The hallmark is an arm pressure higher than the leg pressure, with bounding radial and brachial pulses but weak, delayed or absent femoral pulses. In healthy children the legs read the same as or higher than the arms, and an arm-to-leg systolic gradient of more than 20 mmHg is significant, so the nurse takes blood pressure in all four extremities and compares brachial with femoral pulses. A newborn with critical coarctation develops poor feeding, shock and metabolic acidosis as the ductus closes and needs prostaglandin E1 at once, with continuous breathing monitoring because apnea is its boxed warning. Older children may have headaches, nosebleeds, dizziness or leg cramps with exercise. Coarctation is linked to Turner syndrome and a bicuspid aortic valve. After repair, rebound hypertension needs frequent blood pressure checks, and lifelong follow-up watches for re-narrowing and high blood pressure.
Loading questions…
Go further
- Guide4,852 Measles Cases, and the US Could Lose Its Elimination StatusCDC's 2026 measles count has more than doubled 2025's total, with a PAHO review due this month. What nurses do first: mask, isolate, N95, even if immune.
- GuideCDC's Vaccine Panel Lost All 3 of Its 2026 Meetings to a LawsuitCDC lists every 2026 ACIP meeting as cancelled over litigation. What the court ordered, where the appeal stands, and what nurses should do now.
- GuideHow to Study for Med-Surg: Stop Memorizing, Start ConnectingMed-surg is the first course where memorizing stops working. Start every topic at the mechanism, climb from know-it to spot-it to act-on-it, and practice questions early at the right difficulty — with a real NGN bowtie to try in-page.
Ready to practice this topic?
Get a personalized study plan built around this topic — free to try, no card needed.