Recognition of coarctation of the aorta. A continuing challenge for the primary care physician.

Coarctation of the aorta (CoA) in its classic form presents with characteristic and distinctive physical findings. However, in our survey less than one third of 106 consecutive patients in whom CoA was ultimately diagnosed had the correct diagnosis made by the referring physician. Our survey suggests that in asymptomatic infants and children, an incomplete physical examination explains the diagnostic failure. However, in infants presenting with heart failure, the diagnostic signs of CoA may be obscured and more difficult to recognize even when specifically sought. This survey reaffirms the need for specific physical examination techniques in all infants and children to facilitate early recognition of CoA; these include the palpation of pulses and proper measurement of blood pressure.