Lower extremity blood pressure

Introduction Low blood pressure in the lower extremities is one of the clinical manifestations of abdominal aortic coarctation. The cause is unknown. In view of the small age of some cases (the smallest is only 49 days), some people have proposed a congenital theory: there are two cases of dorsal artery absent with one of the two original tubes, and there are two sides of the fetus. In aortic hyperfusion, there is a mitotic inhibition of smooth muscle cells of the blood vessel wall caused by viruses such as rubella, resulting in the termination of aortic development in the fetus or infant. In view of the fact that some patients have a relatively high age of onset, and there are non-specific arteritis or nodular arteritis in the histological wall of the diseased vessel, some people hold the theory of acquired nature.

Cause

The cause is unknown. In view of the small age of some cases (the smallest is only 49 days), some people have proposed a congenital theory: there are two cases of dorsal artery absent with one of the two original tubes, and there are two sides of the fetus. In aortic hyperfusion, there is a mitotic inhibition of smooth muscle cells of the blood vessel wall caused by viruses such as rubella, resulting in the termination of aortic development in the fetus or infant. In view of the fact that some patients have a relatively high age of onset, and there are non-specific arteritis or nodular arteritis in the histological wall of the lesion, some people hold the theory of acquired nature.

an examination

Related inspection

Dynamic electrocardiogram (Holter monitoring) ECG

The clinical manifestations of the disease: depending on the pathological type and course of disease. Malignant or refractory hypertension is the most common, most meaningful, and sometimes even the only clinical manifestation of this disease, but the lower extremity blood pressure is low or even the femoral artery is not pulsating. Other manifestations include headache, diplopia with progressive encephalopathy, intracranial hemorrhage, heart failure, and weakness of the lower extremities. Signs are audible and vascular murmurs in the abdomen. The average age of diagnosis of this disease is 21 years old.

Complications: complications such as aortic aneurysm rupture, dissection, bacterial endocarditis, aortitis heart failure.

Abdominal aortic coarctation - diagnosis

Some people think that with a stethoscope (abdominal smell and vascular murmur), sphygmomanometer (measured upper limb hypertension and lower limb hypotension) and fingers (upper limb pulsation enhancement, lower limb pulsation weakened or even disappeared) can confirm the disease, but for a comprehensive understanding of the lesion Type, range, and other conditions of affected blood vessels. Imaging studies such as ultrasound, CT, MRI, or angiography are often required. Especially, angiographic imaging can show vascular stenosis in the lesion. The stenosis expands in the proximal vessel and its branches, while the stenosis narrows into the distal vessel, and collateral vessels can also be seen. The expansion supplies blood to the stenosis.

an examination

1. X-ray film: the heart is small or slightly increased, about 1/4 of the patient's heart is moderate to severely enlarged, the left ventricle is enlarged, hypertrophy, and the heart shadow is aortic or intermediate.

2. Electrocardiogram: 1 year old or older, 71% left ventricular hypertrophy, 14% double room hypertrophy. Only 3% of simple right ventricular hypertrophy, another 12% normal.

3. Echocardiography: Transthoracic echocardiography has a good sensitivity to the diagnosis of aortic coarctation. Two-dimensional echocardiography was performed through the sternal fossa. The entire appearance of the long axis of the aortic arch can be used to determine the location and length of the aortic coarctation.

4. CT and MRI: A continuous scan of the aortic arch using contrast enhancement shows the location of the aortic constriction. MRI is suitable for showing the morphological changes such as the relationship between the lumen of the thoracic aorta, the wall of the wall and the left subclavian artery, and the surrounding soft tissue structure.

Differential diagnosis

Differential diagnosis of lower limb blood pressure:

Young patients with this disease need to be differentiated from arteritis. Older patients need to be differentiated from atherosclerotic diseases. In addition to clinical and laboratory results, they should be identified based on histopathology.

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