When performing a physical examination of a person with coarctation of the aorta can hear a distinctive murmur on auscultation of the heart that puts on the trail of the existence of a narrow crossing point of the blood.

Characteristic is the existence of hypertension in the upper trunk and hypotension in the lower extremities. Or hypertension at the tip irrigated by arteries arising before the stenosis and hypotension in the territories irrigated by arteries that come later.

In the chest radiograph as the data is called a sign of 3, introducing the aorta a notch in the area of stenosis. Also be searched costal grooves produced by the enlargement of intercostal arteries increased pressure at this level that leads to the appearance of a mark on the radiograph.

The echocardiogram is able to demonstrate the existence of the difficulty of the passage of blood through the narrow space, and may also be accompanying other congenital coarctation of the existence of two aortic valve leaflets instead of three is a common finding in people with coarctation.

Treatment for coarctation of the aorta

Is treated with repair of the vessel. Currently available options. Can be repaired surgically in an operating room or by a process of cardiac catheterization.

Surgical repair is performed under general anesthesia. The narrowed area is either surgically removed or expanded with the help of surrounding structures or a patch.

The cardiac catheterization procedure may also be a treatment option. During the procedure, we introduce a small flexible tube into a blood vessel in the groin and guided into the heart. Once the catheter is inside the heart, the cardiologist will pass an inflated balloon across the narrowing of the aorta to stretch the area. You can also place a small device (“stent”) in the area of ??narrowing after balloon dilation to keep the aorta open.

The effects that may occur:

- The left ventricle must work harder to move blood through the narrowing of the aorta. Over time, the left ventricle can no longer handle the extra workload and stops pumping blood effectively.
- Blood pressure is higher above the narrowing and reduced below it. Older children may have headaches from too much pressure in the vessels or cramps in the legs or abdomen by the lack of blood flow in the lower body.
- Also, the kidneys can produce enough urine since they require a certain amount of flow and pressure of the blood to do its job.
- The walls of the ascending aorta, aortic arch or any of the arteries of the head and arms may become weakened due to high pressure. Spontaneous tears can occur in any of these arteries and cause a stroke or hemorrhage.

What are the symptoms of coarctation of the aorta?

Symptoms appear when the baby is small are produced by a moderate or severe narrowing of the aorta. However, each child may experience symptoms differently. Symptoms may include:

- Irritability.
- Paleness of the skin.
- Sweat.
- Shortness of breath and/or fast.
- Bad food.
- Insufficient weight gain.

Mild narrowing may not cause any symptoms. Often, they simply have high blood pressure or a heart murmur during a physical examination of school-age child or adolescent. Some may complain of headaches or cramps in your lower body.

Is a birth defect in which there is a narrowing of the aorta at a point of its trajectory, which is usually in the initial portion of it, more frequently after the departure of the great vessels. This narrowing restricts the amount of oxygen-rich blood can move the lower body.

The more severe the narrowing, the greater the symptoms and the problem will be noticed before. In some cases, coarctation is noted in infancy. However, in others it may go unnoticed until school age or adolescence.

What causes coarctation of the aorta?

Some congenital heart defects may have a genetic link. In most cases occur sporadically for no clear reason for their development.

No systematic search is advised unless the following conditions:

In asymptomatic people who have polycystic if another family member had a ruptured aneurysm.

If you were to start another process anticoagulation, thromboembolic disease or atrial fibrillation, for example, as the situation of anticoagulation may pose a greater risk of fatal event in the case of rupture of the aneurysm, after weighing the need for anticoagulation after all.

The most accurate technique for detecting cerebral aneurysms is cerebral arteriography, which involves inserting dye through the arteries to reach the brain. This technique has an appreciable number of risks, from allergic reaction to the contrast of the artery to rupture at different points resulting in a picture of a brain hemorrhage. Reserves for both the detection and treatment of aneurysms when an event has occurred.

Other imaging tests are safer MRI contrast especially to the arteries (MRA) or CT angiography

What treatment should I do?

There is no specific treatment to halt the development of cysts in this disease.

Only symptomatic treatment is performed depending on the complication appears: analgesics for pain, antibiotics for infection …

Treatment of hypertension is similar to the essential form, low-salt diet rich in vegetables and vegetables, regular exercise and different combinations of drugs.

Renal failure remains asymptomatic for a long time and its treatment, when the kidney stops working is definitely dialysis or kidney transplantation.

Are there any special dietary recommendations?

Although no human studies in animals has been that caffeine might foster the growth of cysts, it is recommended to reduce the consumption of beverages that contain coffee, tea, cola, etc..

Even in the absence of hypertension is recommended to reduce salt intake.

It is often asymptomatic and appears on an ultrasound performed for other reasons.

The most common symptom is usually pain by distension of the renal capsule by the growth of cysts or a complication of these (bleeding into a cyst).

It may appear hematuria (blood in urine) with stones and renal colic or without them.

Urine infections are more frequent than in the rest of the population.

Hypertension, especially in the form 1, which is what appears early, can be a sign leading to diagnosis.

The abdominal circumference growth can be just the sign leading to diagnosis.

Why there is hypertension?

The mechanism that produces it seems related to the compression / relaxation of intrarenal arteries from the cysts, leading to a situation of renal ischemia and activate the renin / angiotensin to elevate blood pressure. If not adequately controlled hypertension may accelerate the progression of renal failure in these patients.

What other symptoms can appear?

No alterations in liver function even if present cysts, which occurs earlier in women than in men and more if they have had pregnancies.

The presence of mitral valve prolapse, a valve more resilient and redundant tissue compared to normal, occurs in up to 25% of people with polycystic disease, and only 3% of the normal population. It is usually asymptomatic. Sometimes you can hear a distinctive sound on auscultation and patient feel palpitations. It need not affect the functioning of the heart.

Cerebral hemorrhage due to rupture of an arterial aneurysm is one of the most serious complications. Up to 10% of people with this disease develop aneurysms (dilations) in cerebral arteries, which can break when they grow and produce a clinical picture with intense headache, nausea, vomiting and loss of consciousness, with different consequences from the recovery total death.

In the presence of cysts in the kidney in an imaging test, ultrasound is usually the most innocuous of all.

Since many people have simple cysts require further diagnostic criteria.

If many renal cysts in an adult (over 30 years) and cysts in another territory (liver) the diagnosis is certain.

If there are only cysts in the kidney: There must be more than 3 cysts in the kidney itself or at least 2 in each kidney in a 20 or 30 years with a family history of polycystic disease, to consider that is affected.

Above 50 should be more than 4 cysts in each kidney and family history.

And genetic studies can be made known which genes are involved, three different, localized on chromosome 16 (the form 1), 4 (form 2), and not localized yet (form 3). However, these tests are expensive, require the participation of different members of the family, the more the merrier, and thus are held in very rare occasions. Almost exclusively if a family member is donating a kidney for transplant.

Is it a fatal disease?

Adult polycystic disease is the leading cause in the West of renal failure requiring dialysis, and associated complications that shorten life expectancy of people who have it.

Depending on the affected gene may be more or less aggressive. The form known as PKD1 (English initials Polycystic Kidney Disease) is the most aggressive and shortens life expectancy at age 60. How about PKD2 to 70

However, given its late appearance, the majority of people who have it live a normal life for a long time.

It is the most common genetic disease. It affects nearly 12 million people worldwide. It is estimated that 1 in every 500 adults suffer from it. Is the formation of cysts in the kidney that eventually destroy normal tissue and cause kidney failure.

In addition to renal cysts cysts also occur in other areas: liver, pancreas … and is more frequent occurrence of cerebral artery aneurysms (up to 10%) of mitral valve prolapse, or the occurrence of inguinal hernias and diverticulitis intestinal and renal colic.

Hypertension secondary to this disease is one of the most common secondary forms.

If I have a cyst in the kidney is that I have polycystic disease?

No.

The presence of cysts, called simple, less than 3 in the kidneys of adults, from the 20 to 30 years, is very common and is considered a finding, almost like normal variant.

Are there different diseases that cause kidney stones?

Various diseases which are known manifestation is the appearance of cysts in the kidneys. Adult polycystic disease is transmitted in a pattern called autosomal dominant gene (genes that are altered in different chromosomes are the X or Y is affected and only if a gene for the disease to manifest, but it does to the thirty )

The recessive form called, is much more rare (1 in 10,000 people suffer). The gene is also altered in different chromosomes of the X or Y but in this case the disease appears only if the two genes, from the father and the mother are altered. This disease can occur from early childhood.

There are other diseases that cause kidney stones, some genetic and acquired other, with different clinical courses, but much less frequent.

The acquired form of polycystic kidney disease occurs in people receiving dialysis treatment.

If someone in your family has the disease will have it all?

No, each child will have a 50% chance of inheriting the altered gene and the disease, and the same not having it. Half of the children could therefore transmit the disease and turn. But in each family can have any combination from any child affected them all.

If anyone in my family have the disease for what I do?

Up to 10% of the cases diagnosed there is no family history and is considered a mutation has occurred in that individual. Their descendants if they can inherit.

Most of the time is indistinguishable from essential hypertension, and because of its relatively low incidence is due to study a possible renovascular cause people only have one or more signs of suspicion

- An abdominal bruit is heard
- Hypertension that began before age 30
- Hypertension is started after 50 especially in smokers or patients with signs of atherosclerosis in other territories
- Controlled stable hypertension suddenly becomes more difficult to treat.
- Hypertension requiring multiple medications for adequate control.
- Decrease the size of a unilateral renal imaging test
- Sudden worsening renal function in a hypertensive
- Accelerated or malignant hypertension

Diagnostic tests are:

- A kidney scan or isotopic renogram including the administration of an inhibitor of angiotensin converting enzyme (ACE) inhibitors such as captopril.
- Renal angiography (injection of dye into the renal artery to observe the narrowing of the artery on a radiograph).
- Magnetic resonance angiography: Similar to above but imaging technique of MRI.
- Renal ultrasound Doppler evaluation of renal arteries.
- This disease may also alter the level of renin in the case analyzed.

Sequence usually begins with a diagnostic renal ultrasound with Doppler, the most safe and comfortable and can be diagnostic. If there is conclusive study is completed with renal scan and magnetic resonance angiography. Arteriography or angiography is postponed to the last step also performs diagnostic and therapeutic intent.

Treatment

- Angioplasty with or without stenting, it has become the treatment of choice. It consists of dilating the stenotic area with a balloon that inflates when it comes through the femoral artery to the renal damage. When the stenosis is fibromuscular dysplasia obtained good results in 90% of cases. Failures in atheromatous than 25%.

- Medical treatment, which in most patients is the most appropriate or accurate multi-drug combinations to achieve the optimal level of blood pressure.

- Surgical: when angioplasty fails more than 2 times or is not practicable, you can try rebuilding the artery, making a bridge from another point jumping the obstruction and in some cases it is necessary to remove the kidney, depending on the existing damage in the it.

Hypertension is caused by renal hypoperfusion due to stenosis (narrowing) of the main renal artery or one of its branches. There are two sources for this narrowing: atherosclerotic disease and fibromuscular dysplasia (fibrous and fibromuscular thickening affecting the artery wall).

The first is more common in males, smokers, long-standing hypertension and the elderly.

The second is more common in younger women (under 35 years) that were previously hypertensive. It may be bilateral.

What often appears renovascular hypertension?

Renovascular hypertension is a form of secondary hypertension that occurs in less than 5% of all hypertensive patients. Symptoms usually begin before age 30 or after age 50, depending on the source of damage to blood vessels in the kidneys.

Garlic is one of the best blood purifiers exist and, therefore, it is always recommended in such circumstances. Other plants such as olives or mistletoe, also act in a good way of the bloodstream with similar consequences.

Some people with high blood pressure, fluid retention. In that case, nothing like using the cauda equina, one of the most powerful diuretics and, in turn, produces the elimination of essential minerals, or anything harmful to the body.

Other individuals with high blood pressure which is determined by nervous conditions. In that case, nothing like drinking a soothing herbal teas. Lavender, lime or melissa wonders can go for these specific cases.