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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Coarctation of the aorta

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Acute severe chest or back pain, neurological deficit, haemodynamic collapse or rapidly worsening aortic regurgitation in coarctation may indicate aortic dissection/rupture and needs immediate aortic imaging and specialist transfer.

Synopsis

Detect native or recurrent coarctation, assess whole-aorta complications and maintain lifelong blood-pressure and ACHD surveillance.

  • Measure blood pressure in both arms and at least one leg; upper-limb hypertension with a lower leg pressure and radiofemoral delay is the bedside clue.
  • A systolic murmur over the left infraclavicular area or back and collateral bruits may be present.
  • Coarctation is an aortopathy, not simply a focal narrowing; inspect the arch, repair site and entire thoracic aorta.
  • Bicuspid aortic valve and ascending-aortic dilatation are common associated lesions.
  • CMR is preferred for serial anatomy and flow; CT is valuable for stents, calcification and emergency detail.
  • Intervention is generally indicated for significant obstruction with upper-limb hypertension, particularly when an invasive peak-to-peak gradient is at least 20 mmHg.
  • Hypertension and aortic complications can persist after an anatomically successful repair, so follow-up is lifelong.

Key red flags

Aortic emergency

Sudden tearing chest/back pain, neurological signs or shock suggests dissection or rupture.

Investigation priorities

01
Four-limb blood pressure and pulse examinationFirst step

Screen for haemodynamic obstruction and hypertension.

Management branches

FirstSuspected native or recurrent coarctation

Young or resistant hypertension, arm-leg BP difference, radiofemoral delay or previous repair.

  1. Measure both-arm and leg blood pressures, examine femoral pulses and listen over the precordium and back.
  2. Obtain ECG and expert echo for LV, valve and Doppler assessment.
  3. Refer to an ACHD/aortic service and obtain CMR or CT of the whole thoracic aorta.
  4. Use ambulatory BP and, when appropriate, exercise testing to define the true hypertensive burden.
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Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • ESC 2020 adult congenital heart disease guidelineCoarctation diagnosis, intervention and follow-up.
  • NICE HTG45: balloon angioplasty with or without stentingUK interventional procedure context.
  • NHS England adult congenital heart servicesACHD network care.
  • ESC 2024 peripheral arterial and aortic diseases guidelineAcute and chronic aortic-disease framework.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom