Case Report: Hypertension in a Pediatric Patient With Repeat Aortic Coarctation Repair
Hypertension
As this case illustrates, patients with a history of coarctation repair often develop high BP. Unfortunately, up to 23% of these patients will go on to have BP above the 95th percentile.5 Moreover, a significant number of patients in this population will also suffer from exercise-induced hypertension, even when at-rest BP is controlled with antihypertensive medications.8
β-blockers, angiotensin-receptor blockers, and ACE inhibitors are considered the first-line medications for hypertension in adults and adult-sized patients with this condition.9
Since a high proportion of patients as young as age 7 years may develop high BP postrepair,10 the EP should discuss the initiation of an antihypertensive agent with the patient’s care team prior to discharge. It is also important to keep in mind that elevated BP is present to a significant degree even in patients without recurrent obstruction. The negative sequelae associated with uncontrolled hypertension is well known, and patients with congenital anatomical anomalies are at higher risk for such negative outcomes.
Conclusion
This case illustrates a common presentation of a teenaged patient with a chronic medical condition due to a corrected congenital cardiac defect. It also demonstrates the unique and early opportunity the EP has to evaluate and provide appropriate intervention for patients with potentially life-threatening diseases.
Patients with a history of corrective vascular surgery due to congenital heart malformations are an at-risk population. Therefore, during evaluation, the EP should always keep in mind that that these patients have a higher prevalence of related abnormalities at earlier ages than the general population. Steps initiated in the ED prior to discharge, in collaboration with the patient’s primary- and specialty-care team, can assist in expediting appropriate outpatient management of any sequelae. If a patient does not have a cardiologist, a referral to one should always be made prior to discharge.
Dr Smith is a postgraduate year 3 resident in the department of emergency medicine at Alpert Medical School of Brown University, Providence, Rhode Island. Dr Merritt is an assistant professor and pediatric emergency medicine attending in the department of emergency medicine, Brown Alpert Medical School, Providence, Rhode Island.
