Abstract

Severe hypertension is a well-recognised cause for acute medical admission, and can have serious consequences if untreated. We present a 48 year old patient in whom coarctation of the aorta was identified following the finding of severe hypertension at the time of routine preoperative assessment, and subsequent finding of absent lower limb pulses. The patient had a past history of Apert syndrome, a rare autosomal dominant inherited condition characterised by craniosynostosis, facial dysmorphia, syndactyly of the hands and feet and cardiac abnormalities. This case report highlights the importance of a careful clinical examination in adults with severe hypertension, without which coarctation of the aorta may go undiagnosed.

[download-attachments container="div" style="list" display_icon="1" display_count="1" display__size="0"]

References

1. Cherney D, Straus S. Management of patients with hypertensive urgencies and emergencies: a systematic review of the literature. J Gen Intern Med. 2002;17(12):937-45.
2. DJ K, DA W, RA H, et al 2001 SAEM annual meeting abstracts. Elevated blood pressure in an urban emergency department: prevalence and patient characteristics. Acad Emerg Med 2001;8(5):559.
3. Hypertension EETFftMoA. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2013;31(10):1925-38.
4. Vaughan CJ, Delanty N. Hypertensive emergencies. Lancet.2000;356(9227):411-7.
5. Tulman DB, Stawicki SP, Papadimos TJ, Murphy CV, Bergese SD. Advances in management of acute hypertension: a concise review. Discov Med. 2012;13(72):375-83.
6. Kessler CS, Joudeh Y. Evaluation and treatment of severe asymptomatic hypertension. Am Fam Physician. 2010;81(4):470-6.
7. Charles P, Christopher R. Hypertensive emergencies: acute care evaluation and management Emergency medicine cardiac research and education group; 2008.
8. Stewart DL, Feinstein SE, Colgan R. Hypertensive urgencies and emergencies. Prim Care. 2006;33(3):613-23, v.
9. Rimoldi SF, Scherrer U, Messerli FH. Secondary arterial hypertension: when, who, and how to screen? Eur Heart J. 2014;35(19):1245-54.
10. Mary M. Diagnosis and treatment of secondary hypertension
    http://www.escardio.org/Congresses-&-Events/Congressresources/ESC-Congress-365/Diagnosis-and-treatment-ofsecondary-hypertension: European society of cardiology; 2013[cited 2015].
11. Vergales JE, Gangemi JJ, Rhueban KS, Lim DS. Coarctation of the aorta - the current state of surgical and transcatheter therapies. Curr Cardiol Rev. 2013;9(3):211-9.
12. Tanous D, Benson LN, Horlick EM. Coarctation of the aorta: evaluation and management. Curr Opin Cardiol. 2009;24(6):509-15.
13. Krieger EV, Krieger E, Stout K. The adult with repaired coarctation of the aorta. Heart. 2010;96(20):1676-81.
14. Cevik S, Izgi C, Cevik C. Asymptomatic Severe Aortic Coarctation in an 80-Year-Old Man. 2004;31(4):429-31.
15. GROSS RE. Coarctation of the aorta. Circulation. 1953;7(5):757-68.
16. Kagawa T, Nonoyama A, Kobayashi A. Rib notching: with reference to its various causes and diagnostic implications in cardiovascular diseases. Jpn Circ J. 1968;32(7):989-94.
17. Warne RR, Ong JS, Murray CP. Incidental detection of late presenting co-arctation of the aorta on chest x-ray: the importance of rib notching. BMJ Case Rep. 2012;2012.
18. D AC, Petros N, Bax JJ, Ernst vdW. Myocardial Ischemia in Congenital Heart Disease: The Role of Noninvasive Imaging. Noninvasive Imaging of Myocardial Ischemia: Springer London;p. 287-305.
19. Anagnostopoulos-Tzifa A. Management of aortic coarctation in adults: endovascular versus surgical therapy. Hellenic J Cardiol.2007;48(5):290-5.
20. Oliver JM, Gallego P, Gonzalez A, Aroca A, Bret M, Mesa JM. Risk factors for aortic complications in adults with coarctation of the aorta. J Am Coll Cardiol. 2004;44(8):1641-7.
21. Paul L, J BB, Maarten G, Matthijs B, G HM, A BN, et al. Surgical Versus Percutaneous Treatment of Aortic Coarctation : New Standards in an Era of Transcatheter Repair. Expert Rev Cardiovasc Ther. 2012;10(12):1517 - 31.
22. Celermajer DS, Greaves K. Survivors of coarctation repair: fixed but not cured. Heart. 2002;88(2):113-4.
23. Bhatia PV, Patel PS, Jani YV, Soni NC. Apert’s syndrome: Report of a rare case. J Oral Maxillofac Pathol. 2013;17(2):294-7.
24. Tolarova MM, Harris JA, Ordway DE, Vargervik K. Birth prevalence, mutation rate, sex ratio, parents’ age, and ethnicity in Apert syndrome. Am J Med Genet. 1997;72(4):394-8.
25. Ibrahimi OA, Chiu ES, McCarthy JG, Mohammadi M. Understanding the molecular basis of Apert syndrome. Plast Reconstr Surg. 2005;115(1):264-70.
26. Cohen MM, Kreiborg S. Visceral anomalies in the Apert syndrome. Am J Med Genet. 1993;45(6):758-60.
27. CI S. The Apert Syndrome with coarctation of the aorta. Birth Defects. 1972;8:239-41.
28. N K, ZH Z, KS D. Acrocephalosyndactyly (Apert’s syndrome). Int Surg. 1969;52:380-6.