Delayed Detection of Coarctation of the Aorta Causing Resistant Hypertension in Elderly With Bilateral Parvus et Tardus Renal Doppler Flow Pattern Serving as a Gateway to Diagnosis—A Case Report

Even in the absence of typical physical findings, renal Doppler showing bilateral parvus et tardus flow pattern can widen our differential diagnosis to consider coarctation of the aorta to be a cause of resistant hypertension and further investigate to confirm the diagnosis and treat the condition....

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Bibliographic Details
Published in:Clinical case reports 2024-11, Vol.12 (11), p.e9587-n/a
Main Authors: Ghimire, Jeevan, Shrestha, Prabin, Homagain, Sushan, Paudel, Suruchi, Bhusal, Rabin
Format: Article
Language:English
Subjects:
Abdomen
Acute Medicine
Adults
Antihypertensives
Asymptomatic
Blood pressure
Cardiovascular disease
Case Report
Case reports
coarctation of the aorta
Coronary vessels
Hypertension
Mortality
parvus et tardus
Patients
radio femoral delay
Urine
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Summary:Even in the absence of typical physical findings, renal Doppler showing bilateral parvus et tardus flow pattern can widen our differential diagnosis to consider coarctation of the aorta to be a cause of resistant hypertension and further investigate to confirm the diagnosis and treat the condition. On examination, he had elevated blood pressure (BP) measured in the sitting position (180/110 mmHg on bilateral arms). Parameters Value Reference range Total count 5730 4000–11,000 (cells/μL) Hemoglobin 11.98 g/dL 13–18 (gm/dL) PT/INR 14 s/ 1 11–13.5 s/1–1.5 Random blood sugar 94 mg/dL 70–110 (mg/dL) Blood urea nitrogen 15 mg/dL 8–40 (mg/dL) Creatinine 0.8 mg/dL 0.2–1.2 (mg/dL) Sodium 139 meq/L 135–145 (meq/L) Potassium 4.4 meq/L 3.5–5.5 (meq/L) TSH 2.25 mIU/L 0.5–5 (mIU/L) Urine RE/ME Normal — Urine metanephrine 343.99 mcg/24 h 74–297 (mcg/24 h) Urine normetanephrines 596.95 mcg/24 h 73–808 (mcg/24 h) ECG Sinus rhythm On radiological investigations, renal Doppler showed parvus et tardus waveform in both main renal arteries and interlobar arteries with reduced velocities and decreased acceleration time suggestive of Renal Artery stenosis (Figure 1). The mortality reported in patients with coarctation of the aorta is due to coronary artery disease, heart failure, aortic rupture, endocarditis, cerebrovascular accidents [6].
ISSN:2050-0904
2050-0904
DOI:10.1002/ccr3.9587