Which of the following may be physical examination findings in a young adult with coarctation of the aorta?

A. Posterior systolic murmur between the scapulas.

B. Diminished femoral pulses.

C. Elevated blood pressure in left arm as compared with right arm.

DISCUSSION: A systolic murmur that radiates posteriorly is characteristic of coarctation of the aorta. Coarctation produces obstruction to aortic flow, and thus the femoral pulse has a diminished volume with delayed upstroke. Hypertension in coarctation is multifactorial, but the most important factors are diminished renal flow (single clip, single kidney-Goldblatt model) and mechanical factors. If the right subclavian artery is anomalous and arises distal to the coarctation, blood pressure may be greater in the left arm than in the right. Isolated coarctation does not produce cyanosis.