Diagnosis. treatment and Prognosis of congenital cardiovascular defects (aortic coarctation)

Jonathon Chalmers aged 7 is brought to his GP by his mother. She says he has an ongoing problem with frequent nosebleeds. He gets tired when he plays sports and his mother says that he often complains of a headache and leg cramps, especially on school days which have gym sessions. She does not know whether these symptoms are real or whether he’s faking them so he can avoid the gym. In outward appearance Jonathon presents as a small but healthy 7-year old. Auscultation of his chest reveals normal breath sounds but a systolic murmur can be heard over the upper back. Blood pressure is 140/100 in his arms, but 90/75 in both legs. There are no obvious ECG abnormalities. The GP advises the parents that Jonathon may have a congenital problem with his cardiovascular system, and if this is the case, the sooner treatment is initiated the better. He refers Jonathon to hospital where after further tests a paediatric cardiologist confirms the diagnosis. Jonathon then undergoes a surgical procedure to remedy his problem. He recovers quickly from the surgery and is able to return home. However, his parents are warned that his condition, especially his blood pressure, will need to be closely monitored for some time to come, as there may be other abnormalities in his cardiovascular system which could cause problems later.                                                        

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