A SEVERE COARCTATION OF THE AORTA IN A 36 Y OLD MAN WITH PRELIMINARY ASSESSMENTS AS RESISTANT HYPERTENSION

Objective: Patient 36-year-old Mmale. Admitted to Yerevan Scientific MC with elevated blood pressure, and complaints of discomfort in the chest, which was related to taking food, according to his words. The patient mentions multiple referrals to different medical facilities in recent years due to increased blood pressure. Pronounced a headache in the cranial region. caused by physical exertion. Design and method: Ecg, Echocardiography, Laboratory examinations Results: BP -180/110 and 165/90 mm Hg. In both arms. Cardiovascular system: there was a systolic murmur in the left infraclavicular area. A systolic ejection murmur was heard at the left upper sternal border. Ecg-Normal sinus rhythm. Left axis deviation. T-wave inversions in leads III and aVF. Laboratory findings, cardiac damage markers, NT-proBNP -without any abnormalities. Echocardiography-LV wall hypertrophy. Preserved LV systolic function. An additional chord is visible in the LV. The aortic ampulla enlarged to 36 mm, with mild acceleration of flow in the arch. It is recommended aortography. CT-Aorta: Upper aorta - 3.8 cm, Aortic arch in the normal location, proximal - 3.1 cm in diameter (normal 3.3 cm), distal - 2.1 cm in diameter, Descending aorta: At a distance of 1.5 cm from the left subclavian artery, focally narrowed -up to 0.4 cm, the walls are thickened, pre stenotic - 2.1 cm, post stenotic - 2.3 cm in diameter. Conclusions: Coarctation of the aorta is a common cause of secondary hypertension in children, especially males, but may not be detected until adulthood because it is often asymptomatic, accounts for 5–8% of all congenital heart diseases. Without correction, the mean life expectancy of patients with CoA is 35 years and 90% of those patients die before reaching the age of 50 years. And is a congenital cardiac malformation that can go undiagnosed until old age with only hypertension as a marker of its presence because clinical signs can be subtle and overlooked if a complete physical exam is not performed. The patient was successfully treated with intervention, by balloon angioplasty with deployment of a covered stent. Result of dynamic computer tomography. Status post stenting of the descending aorta. Pronounced reduction of intercostal and internal thoracic collaterals. Long-term therapy after the intervention -aspirin, nebivolol, Rosuvastatin. No increase in blood pressure was observed after the intervention.