![]() ![]() 4 It is defined as complete discontinuity of the aortic lumen between the ascending and descending portions of the thoracic aorta. IAA is a rare congenital malformation that occurs in 3/1 000 000 live births, accounting for 1% of all congenital heart disease. ![]() The case was considered for surgical repair but, in view of the absence of symptoms, good blood pressure control and effective collateral circulation, a strategy of delayed intervention and close clinical surveillance was chosen. The patient was asymptomatic, with controlled hypertension and no symptoms of claudication, despite the distal aortic hypoplasia and pressure gradient between upper and lower limbs. Chest radiography showed normal cardiac silhouette and bilateral rib notching ( Figure 2). On the 12-lead electrocardiogram he had incomplete right bundle branch block and left ventricular hypertrophy. No cardiac, dorsal or abdominal murmurs were audible. Lower limb pulses were weakly palpable and blood pressure was significantly lower (80/60 mmHg), so aortic coarctation was considered. Blood pressure was 135/80 mmHg in both arms. Due to a poor suprasternal view, the aortic arch could not be observed. The aortic valve was tricuspid with mild central regurgitation, and the left ventricle presented normal dimensions, mild concentric hypertrophy and preserved systolic function ( Figure 1B–D). With a presumed diagnosis of essential hypertension, the patient remained asymptomatic and with well-controlled blood pressure in the following years, taking irbesartan 300 mg plus hydrochlorothiazide 12.5 mg/day and amlodipine 5 mg/day.Īt the age of 47, he was referred to our hospital's outpatient cardiology clinic due to mild dilatation of the aortic root and ascending aorta detected on a transthoracic echocardiogram ( Figure 1A). Laboratory and imaging studies were performed with no apparent secondary causes of hypertension detected. He was then referred to an outpatient hypertension clinic for management and etiological study. At 40 years old, he suffered an intracranial hemorrhage due to rupture of a right anterior choroidal artery aneurysm and underwent aneurysm clipping. We present the case of a 47-year-old male patient with a history of untreated high blood pressure since the age of 25. However, there are reports showing that the diagnosis is often missed and a significant number of asymptomatic subjects are probably not detected until adulthood. These entities can be easily diagnosed on physical examination, by palpation of the brachial and femoral arterial pulses and blood pressure measurement in the four limbs. 2Īortic coarctation and interrupted aortic arch (IAA) are examples of rare potential secondary causes of hypertension in adults. A detailed medical history and a rigorous physical examination have a pivotal role in the accurate diagnosis of hypertension, particularly for the detection of underlying secondary causes. 1 Appropriate diagnosis and treatment are important in reducing hypertension-related morbidity, mortality and costs. Hypertension is an increasingly important medical and public health issue, with an overall prevalence of 30–45% of the general population. ![]()
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