Pediatric Cardiology
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þ Coarctation
 - Classic presentation:
  + headache
  + clammy legs
 - Clues on CXR:
  + Will often show notching of ribs from arterial hyperperfusion
  + Can use pattern of which ribs show notching to estimate level of
    coarctation

      A child has a supraclavicular bruit.  It is heard best on the
        right side of the chest when the child is upright.  It can be
          made to disappear by having the patient bend the arms at the
            elbows and hyperextend them.  What is the significance of this?


            _________
            o Answer:
              This is an innocent murmur caused by turbulent flow at the
                branching site of the brachiocephalic arterial vessels.  It
                  does not signify a pathologic condition.

                  ____________
                  o Reference:
                    Rosen 3rd ed. p 2786