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Measurement of leg blood pressure: the most straightforward way to the diagnosis
R Gilles1, B A J Veldman, W R M Aengevaeren
1Department of Medicine, Division of General Internal Medicine, Nijmegen, the Netherlands. R.Gilles@nucmed.umcn.nl
Insights
Diagnosing coarctation of the aorta in adults is crucial for hypertension management. Measuring leg blood pressure is vital for identifying this condition, especially with murmurs or weak pulses.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Primary hypertension is a common diagnosis in adults.
- Coarctation of the aorta can present in adulthood, mimicking primary hypertension.
- Delayed diagnosis of coarctation of the aorta can lead to significant morbidity.
Observation:
- Two adult patients presented with hypertension, initially presumed to be primary.
- One patient had a straightforward diagnosis of coarctation of the aorta with characteristic physical findings.
- The second patient experienced a diagnostic delay, with hypertension unresponsive to treatment, eventually diagnosed with coarctation of the aorta after extensive investigation.
Findings:
- Severe coarctation of the thoracic aorta identified via magnetic resonance imaging angiography in the first patient.
- Extensive collateral blood vessels observed in both patients, including abdominal collaterals in the second patient.
- Leg blood pressure measurement was key in diagnosing coarctation of the aorta in both adult cases.
Implications:
- Emphasizes the importance of measuring leg blood pressure in all adult hypertensive patients.
- Highlights the need for considering coarctation of the aorta in hypertensive patients with cardiac murmurs or weak femoral pulses.
- Suggests that routine leg blood pressure measurement could prevent diagnostic delays for adult coarctation of the aorta.
Abstract:
Two adult patients with presumed primary hypertension are presented. In the first patient the diagnosis of coarctation of the aorta was straightforward while in the second patient there was a substantial delay in reaching the correct diagnosis. A 32-year-old patient was analysed for hypertension in the outpatient clinic. At physical examination a systolic cardiac murmur was present and leg blood pressure was not measurable. Magnetic resonance imaging angiography showed a severe coarctation of the thoracic aorta with extensive distended collateral blood vessels. A second patient was a 31-year-old man referred with longstanding hypertension and an unsatisfactory blood pressure response to treatment. Previously, a diagnosis of primary hypertension was made. Renal computed tomography angiography excluded renal artery stenosis as a cause of hypertension but disclosed many distended collateral blood vessels in the musculus rectus abdominis and in the upper abdominal area. Leg blood pressure was measured and further analysis revealed a coarctation of the aorta. Both patients illustrate and emphasise the importance of leg blood pressure measurement at a first analysis of adult hypertensive patients and should always be performed when hypertension is accompanied by murmurs or weak femoral pulsations.
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