Clinical features

Presentation in the neonatal period occurs where aortic blood flow is dependent on ductal patency. In this case previously normal femoral pulses may disappear between 2 to 6 days of age with the closure of the ductus arteriosus, and symptoms arise at around this time. Features are similar to those of acute heart failure or sepsis.

In later life possible clinical features include:

• often asymptomatic for many years
• symptoms secondary to systemic hypertension such as headaches, nose bleeds etc
• symptoms secondary to poor blood flow in the lower limbs, for example claudication, cold legs
• hypertension in upper limbs with reduced pressure in the lower limbs
• radiofemoral delay or absent femoral pulses in 88%
• a mid to late systolic murmur
• possible vascular bruits from the collateral circulation may be heard

Note that it is sometimes difficult to feel the femoral pulses during the neonatal check. However if there is a strong dorsalis pedis pulse the examiner can be reassured that coarctation is unlikely. If absent femoral pulses are found then a paediatric (expert) opinon should be sought regarding further management.