Late diagnosis of severe aortic coarctation in a 65-year-old endurance athlete: Insights into exercise physiology and collateral compensation

Background: Coarctation of the aorta (CoA) is a relatively rare congenital narrowing of the distal aortic arch to proximal descending thoracic aorta, usually diagnosed in infancy or early childhood with upper extremity hypertension as a typical finding. Late detection in asymptomatic, physically active older adults is rare and can be clinically significant. Case presentation: We present the case of a 65-year-old lifelong endurance athlete found to have transient severe left ventricular (LV) systolic dysfunction after completing a marathon. Stress testing revealed a hypertensive response, prompting cardiac MRI, which detected a new severe juxta-ductal CoA with collateralization. The patient underwent successful endovascular stenting with improved blood pressure response and stabilization of LV function. Conclusion: This case underscores the importance of thorough cardiovascular assessment in older athletes and highlights the impact of lifelong exercise in compensating for congenital defects like CoA.