The patient had resistant hypertension, with no assignable cause of secondary hypertension despite “scores of tests” and evaluation by numerous doctors at Yale’s specialty clinic. It was known that she had a murmur and bruits as well as claudications and absent ankle pulses. What’s the final answer? Coarctation of the aorta, finally revealed by an echocardiogram.
It’s an important clinical lesson (always think of coarct when you’re looking for secondary hypertension) but there’s a little something wrong with this story. Either the NYT account is simplistic or the folks at Yale made some sophomoric mistakes. (I suspect the former).
When I read a story like this I’m in the “quiz mode.” It’s different in the hectic, mind numbing, day to day clinical world. But it’s not rocket science to check for radiofemoral delay and take upper and lower extremity blood pressures. It’s hypertension 101 to perform these maneuvers and think of coarctation. And this was a specialty clinic. Equally strange is that she had had all these tests including rennin profiling, magnetic resonance imaging and angiography before getting a simple echo.
I can hardly imagine this happened at Yale’s hypertension clinic. Did the New York Times feel the need to dumb the presentation down for the lay public?