Last reviewed:September 2019
Last updated:January  2018



History and exam

Key diagnostic factors

  • hypertension presenting at a young age or resistant to treatment
  • diminished lower extremity pulses
  • differential upper and lower extremity blood pressure (BP)

Other diagnostic factors

  • systolic ejection murmur
  • male gender
  • genetic syndrome
  • claudication
  • headache
  • systolic ejection click
  • other cardiac anomalies

Risk factors

  • male gender
  • young age
  • FHx
  • Turner syndrome
  • DiGeorge syndrome
  • hypoplastic left heart syndrome
  • Shone complex
  • PHACE syndrome

Diagnostic investigations

1st investigations to order

  • ECG
  • chest x-ray (CXR)
  • echocardiogram
Full details

Investigations to consider

  • computed tomography (CT) angiography
  • magnetic resonance angiography
  • cardiac catheterization
Full details

Treatment algorithm


Jeffrey Gossett

Director Heart Failure, Heart Transplantation

Professor of Pediatrics

Division of Pediatric Cardiology

University of California, San Francisco

San Francisco



JG declares that he has no competing interests.

Dr Jeffrey Gossett wishes to gratefully acknowledge Dr Anna Kamp, a previous contributor to this topic. AK declares that she has no competing interests.

Peer reviewersVIEW ALL

Clinical Assistant Professor of Pediatrics

University of Michigan

Ann Arbor



RA declares that he has no competing interests.

Consultant Paediatric Cardiologist and Honorary Senior Lecturer

Great Ormond Street Hospital and Institute of Child Health




SK declares that he has no competing interests.

Use of this content is subject to our disclaimer