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.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate
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.
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.
Measure both-arm and leg blood pressures, examine femoral pulses and listen over the precordium and back.
Obtain ECG and expert echo for LV, valve and Doppler assessment.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.