Coarctation of the aorta: difficulties in clinical recognition.

Coarctation can be recognized by physical examination alone early in a person's life, except in instances in which the obstruction is very mild. While some cases remain mild for a lifetime, others become progressively worse during adolescence or adulthood with typical manifestations of upper-extremity hypertension and imperceptible pulses in the lower extremities. It is especially urgent and sometimes difficult to recognize coarctation in infants with congestive cardiac failure just as it is to identify older children and adolescents with asymptomatic but severe systemic hypertension. There may be medical or legal implications in failing to do so.