Which finding is most typical of coarctation of the aorta?

• A. Delated and weakened femoral pulses with lower leg blood pressure compared to the arms
• B. Early systolic murmur in the lungs
• C. Elevated ankles with high blood pressure
• D. Absent radial pulses only

Answer: (A)

Coarctation of the aorta creates a narrowing that raises pressure before the constriction and reduces flow beyond it. The hallmark is upper-extremity hypertension with diminished, delayed femoral pulses and lower leg blood pressures compared with the arms. This brachial-femoral delay, where the femoral pulse is weaker and slower to appear than the radial pulse, reflects the distal obstruction. A murmur may be present, but it’s often best heard on the back or between the scapulae rather than as an early systolic murmur in the lungs. Leg pressures being higher is not typical; they are lower due to reduced distal perfusion. Absence of radial pulses alone isn’t characteristic since upper-extremity pulses can be normal. Thus the classic finding is the delayed, weakened femoral pulses with lower leg blood pressure relative to the arms.