A patient complains of intermittent claudication, dizziness and headache; likely cardiac lesion is:

Answer is D (Coarctation of aoa) Intermittent claudication, dizziness and headache are all suggestive of coarctation of aoa Coarctation of Aoa: Review Clinical presentation : * Most patients are asymptomatic Q * Symptomatic patients usually present with : - Headache, dizziness,Q - Epistaxis - Cold extremities, and weakness in the legs - Claudication with exercise e * Hypeension in upper extremities with marked diminution of pulsation in lower extremities. Q * Mid systolic or continuous murmur over anterior pa of chest and backQ * Enlarged and pulsatile collateral vessels in intercostal spaces anteriorly in axilla or posteriorly in interscapular areaQ * Upper extremity and thorax may be more developed than lower extremities. Q Investigations : * ECG: shows L.V. Hyperophy Q * Radiography : - Indentation of aoa at site of coarctation and '3 sign' on paramediastinal shaddon are almost pathogenicQ - Notching (erosion) of inferior surfaces of ribs. Q Complications : * Cerebral aneurysms and haemorrhage Q * Rupture of aoa * Left ventricular failure Q * Infective endocarditis Q Treatment : * Is surgical resection Q of 'coarctation' and end to end anastomosis Remember that HT may not be corrected even after surgical correction of the 'coarctation'. (1 Few other questions : * Most common site of coarctation of aoa : distal to origin of left subclan aery. Q Most common associated cardiac anomaly Q : bicuspid aoic valve.Q May be associated withQ : Turner's syndrome. Q