Arterial Hypertension Revealing a Tight Aortic Coarctation in a Young Patient: About a Case

Abstract

Objective: Coarctation of the aorta is an obstructive lesion responsible for high blood pressure (hypertension). The diagnosis of coarctation is usually made during the first months of life but can be mentioned much later, especially when there is no other associated heart disease. Design and method: we report a case of a tight aortic coarctation in a young person revealed by arterial hypertension. Results: Mr K.H, 24 years old, with no notable pathological history, admitted for fever, cough and purulent sputum. At the examination the patient was polypneic, BP was 16/7, cardiac auscultation revealed a diastolic murmur to the aortic focus and reduced femoral pulses. Infectious endocarditis was suspected. Transesophageal ultrasound showed grade IV aortic insufficiency, aortic bicuspid, aneurysmal dilatation of the ascending aorta, and absence of endocardial adenoids. The thoracic angio scanner noted a short and tight stenosis of the aortic isthmus, a funnel dilation of the arch of the aorta with a significant aneurysmal dilation of the ascending aorta without signs of dissection, a focus of right lower lobar pneumonia. The diagnosis of hypertension secondary to coartation of the aorta was then retained. The patient was put on antibiotic therapy for his infectious lung disease, on antihypertensive treatment. Conclusions: This clinical fact underscores the importance of measuring blood pressure during any examination of a patient. Indeed, an isthmic coarctation can be easily ignored because, apart from hypertension, the damping of the femoral pulses is often the only clinical sign.