Delayed Diagnosis of Coarctation of the Aorta as a Cause of Secondary Hypertension in an Adult Female With Congenital Heart Disease: A Missed Opportunity for an Earlier Diagnosis?

Coarctation of the aorta (CoA) is a narrowing of the aorta that typically occurs just after the point where the left subclavian artery branches off. This is usually around the area where the ductus arteriosus used to connect to the aorta in foetal life. Most cases are sporadic; however, genetic associations have also been established in some cases. Generally, it leads to heart failure symptoms at an early age, but later presentation beyond adulthood often remains asymptomatic. Clinical suspicion about the condition usually arises in patients with uncontrolled blood pressure and reduced or absent femoral pulses. We present a case of a 30-year-old female patient known to have congenital heart disease (ventricular septal defect and moderate tricuspid regurgitation) who suffered from infective endocarditis in her adolescent years (treated successfully medically) and presented years later with uncontrolled blood pressure, palpitations, and headaches. With the help of a workup for hypertension in the young, especially imaging, and a close follow-up, she was diagnosed with CoA, which has a strong association with other congenital heart diseases. She underwent stenting of the lesion, with a successful outcome and reasonable control of blood pressure.