Patient education: Aortic coarctation in adults (The Basics)

What is aortic coarctation? — Aortic coarctation is a heart defect that causes the heart's largest vessel, called the "aorta," to narrow (figure 1). People with this condition are born with it. But they might not find out that they have the condition until they are adults. People with aortic coarctation often also have a heart valve problem.

What are the symptoms of aortic coarctation? — Most people with aortic coarctation do not have any symptoms. But some do have 1 or more of the following symptoms:

●Headache

●Nosebleeds

●Trouble breathing, especially when exercising

●Fatigue

●Leg cramps

●Chest pain – People with aortic coarctation can develop a couple of different types of chest pain:

•Chest pain, pressure, or discomfort that happens when the heart muscle does not get enough blood to supply its needs. The medical term for this type of chest pain is "angina."

•A severe, sharp, "tearing" pain in the chest or back that is caused by a tear in the aorta. Medical terms for a tear in the aorta are "aortic dissection" or "aortic rupture."

●Sudden facial droop or uneven face, weakness or numbness in an arm, or trouble speaking – These are symptoms of a stroke. A stroke is when a part of the brain is damaged because of a problem with blood flow. Strokes can happen if an artery in the brain closes off or starts to bleed.

People with aortic coarctation usually have high blood pressure in their arms (especially the right arm) but low blood pressure in their legs. Also, their pulse is much weaker in the groin area than in the neck or arms.

Are there tests for aortic coarctation? — Yes. The doctor will do an exam and measure your pulse and blood pressure in your arms and legs. Other tests include:

●An electrocardiogram – This test measures the electrical activity of the heart. It is also called an "ECG."

●A chest X-ray – A chest X-ray shows if there is fluid in the lungs. This can happen if the heart is not working as well as it should. It also lets the doctor see the general shape of the heart and the large blood vessels in the chest. In some people with aortic coarctation, the chest X-ray shows some changes in the ribs.

●An echocardiogram – This test uses sound waves to take pictures of your heart and aorta.

●An MRI or CT scan – These tests take pictures of your aorta, as well as the blood vessels in the head.

●Cardiac catheterization (also called "cardiac cath") – During this test, the doctor puts a thin tube into a blood vessel in your leg or arm. Then, they move the tube up to your heart. Next, the doctor puts a dye that shows up on X-rays into the tube. This part of the test is called "angiography." It can show how much your aorta has narrowed. The doctor might also use dye to look at the blood supply to the heart.

How is aortic coarctation treated? — High blood pressure is common in people with aortic coarctation. Medicines are used to treat high blood pressure.

Some people with aortic coarctation need a procedure to fix the aorta. The type of procedure depends how much your aorta has narrowed, your symptoms, and your age. Procedures include:

●Angioplasty – During angioplasty, a doctor puts a thin tube into a blood vessel in the leg or arm and moves the tube to the aorta. Then, the doctor inflates a balloon inside the narrow part of the aorta to widen it. In some cases, the doctor props open the aorta using a mesh tube called a "stent."

●Surgery – Different types of surgery can fix the narrowed aorta. The surgeon might remove the narrowed part of the aorta. In some cases, they use a plastic tube called a "graft" or a piece of another one of your blood vessels to fix the aorta.

What if I want to get pregnant? — Talk to your doctor about the risks of getting pregnant if you have aortic coarctation. Most people who have had their coarctation successfully fixed can have a baby safely.

For some people who have not been treated for aortic coarctation, pregnancy can be dangerous and, in rare cases, fatal. The most common problem is high blood pressure. Most people whose blood pressure is normal during pregnancy can have the coarctation fixed after the baby is born. But if your blood pressure gets too high, you might need to take medicine to control it. In some cases, you might need a procedure to fix the aorta before you give birth.

What will my life be like? — Many people with aortic coarctation are able to live normal lives. But high blood pressure and aortic coarctation can return after treatment. You will need to see your doctor regularly and get follow-up testing as recommended. Also, you should check with your doctor about what types of exercise you can do.

More on this topic

Patient education: High blood pressure in adults (The Basics)
Patient education: Stroke (The Basics)
Patient education: Aortic dissection (The Basics)
Patient education: Coronary artery disease (The Basics)