When Heather had her yearly physical, her doctor noticed that
her blood pressure was high and ordered tests to determine what was
causing it. It turned out Heather had a heart condition known as
coarctation of the aorta.
Heather was surprised, and understandably a little worried. But
she was relieved to hear that the problem could be treated and that
she could still live a normal life.
What Is Coarctation of the Aorta?
The
aorta
(pronounced: ay-
or
-tuh) is the major artery that carries blood away from the heart to
the body. When someone has coarctation of the aorta, that
person's aorta is narrowed at some point.
Here's how a healthy heart and aorta work: Blood that needs
oxygen comes from all over the body and enters the right side of
the heart, which pumps it to the lungs. The lungs fill the blood
with oxygen, and this oxygen-rich blood returns from the lungs to
the left side of the heart. The left side of the heart finishes by
pumping the blood out through the aorta. From the aorta, the blood
travels through arteries that reach all of the body's organs
and tissues, bringing them oxygen. Then the blood returns to the
heart through veins and restarts the cycle.
When part of the aorta is narrowed, called a
coarctation
(pronounced: ko-ark-
tay
-shun), the defect can affect the body's blood circulation
because the left side of the heart has to work harder to pump blood
through the narrowed aorta. Sometimes the narrowing is minor and
may not even cause symptoms. In other cases the aorta may be more
constricted, placing a strain on the heart's left
ventricle
(the chamber that pumps blood to the aorta and out to the body). A
coarctation can occur anywhere in the aorta, but it is most often
found just beyond the point where the aorta sends a branch off to
supply the left arm.
What Causes Coarctation of the Aorta?
Coarctation of the aorta, COA for short, is a
congenital
defect, meaning it's present at birth. Doctors don't know
for sure why certain people are born with COA.
Guys are almost twice as likely to have COA than girls. In many
people, the defect shows up with other birth defects or conditions,
such as a ventricular septal defect (a hole in the wall between the
heart's left and right ventricles). COA is also fairly common
in girls born with
Turner syndrome
, a genetic disorder in which one of a girl's two X chromosomes
is incomplete or missing.
Most people with COA are diagnosed when they are babies or young
children. But some, like Heather, may not be diagnosed until they
are teens or even adults. When people aren't diagnosed until
their teens, it's usually because the narrowing in the aorta is
not severe enough to cause serious symptoms while the person is
very young. But even people who don't have major symptoms
usually need treatment because COA can eventually cause problems.
The heart defect won't just go away on its own.
Signs and Symptoms
Teens and adults who have COA often do not have any symptoms or
have only mild signs that are discovered during a regular visit to
the doctor. Someone with symptoms may notice some or all of
these:
- cold legs and feet
- shortness of breath, especially when exercising
- dizziness
- leg cramps after exercising
- strong, throbbing headaches
- fatigue
- nosebleeds
- fainting
- chest pain
Often the first sign that someone has COA is an abnormal blood
pressure test. During a physical exam, the doctor may find that a
person with a coarctation has higher blood pressure in the arms
than in the legs. The doctor may also hear a heart murmur or notice
that the pulses felt in the groin area or on the feet are weak or
even absent.
Diagnosis and Treatment
If a teen has the signs or symptoms of COA, the doctor may refer
him or her to a pediatric cardiologist - a doctor who specializes
in diagnosing and treating heart disease in kids and teens. The
cardiologist will listen to the heart, feel the pulses, measure
blood pressure, and will probably order an
echocardiogram
, a test that uses sound waves to create a picture of the heart and
its circulation. A cardiologist may also use other tests that
produce images of the heart, such as a chest X-ray, a magnetic
resonance imaging (MRI) test or a computerized tomography (CT) scan
to look for a narrowing of the aorta.
Doctors often recommend that COA be treated quickly, especially
in teens and adults. The longer a COA is left untreated, the more
likely it is that the person will have high blood pressure even
after the COA is fixed. If it's left untreated indefinitely,
the defect can be fatal in many people by the age of 40.
Coarctation of the aorta can be repaired in several ways.
Surgery can very effectively repair a narrowing of the aorta,
usually by removing the narrow section and reconnecting the
two good ends of the aorta. In some cases, doctors may choose to do
a procedure known as
balloon dilation
, which is also called
balloon angioplasty
(pronounced:
an
-jee-oh-plas-tee). This is performed in a cardiac catheterization
laboratory rather than an operating room and there is no real scar.
For this procedure, a cardiologist inserts a tiny catheter (plastic
tube) into a blood vessel in the leg and uses a very thin wire to
thread it up to the aorta. This specialized catheter has a deflated
balloon inside. When the catheter is in the aorta, the doctor
inflates the balloon, expanding the narrow spot. After the area has
been widened, the balloon is removed. The cardiologist may also
implant a device called a
stent
, which is a tube made of metal meshwork, to keep the area open
after the procedure.
Taking Care of Yourself
After the defect is fixed, most symptoms of COA disappear
quickly because the blockage that caused them is gone. Some people
will still have high blood pressure for a while and may have to
take medicine to control it.
People who have surgery often feel completely better after a
couple of weeks, and those who have had the balloon treatment feel
better even sooner, often within a couple of days. But doctors
recommend that all patients avoid certain physical activities -
especially lifting heavy objects or playing certain sports - for
several weeks or months to give their bodies enough time to heal.
Someone whose blood pressure remains high may have to continue to
limit certain activities as long as he or she has high blood
pressure.
People who've had a COA corrected will still need to be
monitored over time. In some, the narrowing of the aorta can return
after surgery or balloon dilation treatment. Regular visits to a
cardiologist - often every year or 2 after the person has fully
recovered - let the doctor keep an eye on a person's blood
pressure and look for signs that COA could be returning.
Patients also need to monitor themselves and call the doctor if
they have shortness of breath, chest pain, or fainting. But
overall, teens like Heather who have coarctation of the aorta can
expect to continue leading a normal life after treatment.
Reviewed by:
Gina Baffa, MD
Date reviewed: September 2006
Originally reviewed by:
Terrence U. H. Chun, MD
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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