Aortic coarctation as a rare cause of hypertension in the elderly
Coartación aórtica como causa poco frecuente de hipertensión arterial en el anciano
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Álvarez Tundidor, Carlos Ruiz-Zorrilla López, B. Gómez Giralda, A. Molina" "autores" => array:4 [ 0 => array:3 [ "Iniciales" => "S." "apellidos" => "Álvarez Tundidor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:4 [ "nombre" => "Carlos" "apellidos" => "Ruiz-Zorrilla López" "email" => array:1 [ 0 => "carlosruizzorrilla@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "Iniciales" => "B." "apellidos" => "Gómez Giralda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "Iniciales" => "A." "apellidos" => "Molina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Río Hortega, Valladolid, España, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Coartación aórtica como causa poco frecuente de hipertensión arterial en el anciano" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1022318078_f1_pag136.jpg" "Alto" => 242 "Ancho" => 263 "Tamanyo" => 7877 ] ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">Dear Editor,</span></p><p class="elsevierStylePara">Hypertension in the elderly is mainly essential with coarctation of the aorta a secondary cause.<span class="elsevierStyleSup">1</span> The median survival of patients with coarctation of the aorta is low: only 25% live past 50 years of age.<span class="elsevierStyleSup">2,3</span> Most cases are women, due to a lower tendency to develop atherosclerosis and hypertension.<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara">Below is the case of a male patient aged 83 who was admitted for surgery of the left paranasal squamous cell carcinoma, which appeared as a complication in a compressive cervical haematoma that required urgent tracheotomy. His background revealed longstanding refractory hypertension. A physical examination revealed a normal cardiopulmonary auscultation with distal pulses present on the upper limbs and diminished in the lower. Blood pressure in the upper right extremity was 182/81mmHg, significantly higher than the left side, where it was 130/75mmHg. The latter was similar to those of the  lower extremities. Analytically, the data showed no renal secondary hypertension, thyroid or kidney disease. The echocardiogram revealed a significant hypertrophy of the left ventricle in septal location. A slight cardiomegaly and the inverted E sign (Figure 1) were observed on the radiograph which, together with the difference in blood pressure in both upper  extremities, directed us towards a diagnosis of probable aortic coarctation.</p><p class="elsevierStylePara">Therefore, a chest CT was performed with contrast. This revealed, in the aortic arch, distal to the supra-aortic trunks, a poststenotic dilatation of a maximum of 3.7cm in diameter, compatible with aortic coarctation (Figure 2).</p><p class="elsevierStylePara">After assessing the clinical status, the tumour staging (T2, N2b, M0) and the high comorbidity of surgery, conservative treatment was chosen.</p><p class="elsevierStylePara">In conclusion, the diagnosis of aortic coarctation should always be discarded for any patient with refractory hypertension. A proper physical examination with palpation of distal pulses and measurement of blood pressure control between extremities is a good guide towards diagnosis.</p><p class="elsevierStylePara"><a href="grande/1022318078_f1_pag136.jpg" class="elsevierStyleCrossRefs"><img src="1022318078_f1_pag136.jpg"></img></a></p><p class="elsevierStylePara">Figure 1. </p><p class="elsevierStylePara"><a href="grande/1022318078_f2_pag136.jpg" class="elsevierStyleCrossRefs"><img src="1022318078_f2_pag136.jpg"></img></a></p><p class="elsevierStylePara">Figure 2. </p>" "pdfFichero" => "P1-E43-S1792-A10223-EN.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1022318078_f1_pag136.jpg" "Alto" => 242 "Ancho" => 263 "Tamanyo" => 7877 ] ] ] 1 => array:7 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "1022318078_f2_pag136.jpg" "Alto" => 220 "Ancho" => 261 "Tamanyo" => 13117 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Convens C, Vermeersch P, Paelinck B, Van den Heuvel P, Van den Branden F. Aortic coarctation: A rare unespected cause of secondary arterial hypertension in the ederly. Catheterization and Cardiovascular Diagnosis 1996;39:71-4. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8874951" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Miro O, Jiménez S, González J, et al. Highly effective compensatory mechanisms in a 76- year-old man with a coarctation of the aorta. Cardiology 1999;92:284-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10844392" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Therrien J, Gatzoulis M, Grahan T, et al. Canadian Cardiovascular Society Consensus Conference 2001 up date: recommendations for the management of adults with congenital heart disease: part II. Can J Cardiol 2001;17:1029-50. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11694894" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Perloff JK. Coarctation of the aorta. Philadelphia: WB. Saunders, 1987;125-60." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003000000001/v0_201502091608/X2013251410033843/v0_201502091609/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003000000001/v0_201502091608/X2013251410033843/v0_201502091609/en/P1-E43-S1792-A10223-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251410033843?idApp=UINPBA000064" ]
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