A 5-year-old child has an elevated blood pressure during a well child exam. The primary care pediatric nurse practitioner notes mottling and pallor of the child's feet and lower legs and auscultates a systolic ejection murmur in the left infraclavicular region radiating to the child's back. The nurse practitioner will suspect which condition?

Question

Quizplus · Accepted Answer

The mottling and pallor in the lower extremities combined with the systolic ejection murmur in the left infraclavicular region radiating to the back are suggestive of coarctation of the aorta. Coarctation of the aorta is a narrowing of the aorta usually at the site of the ductus arteriosus. This narrowing can reduce blood flow to the lower extremities, causing decreased perfusion and mottling. The systolic ejection murmur is caused by turbulent blood flow through the narrowed aorta. Aortic stenosis would present with a harsh systolic ejection murmur at the base of the heart, but would not typically cause mottling or pallor in the lower extremities. Patent ductus arteriosus would cause a continuous machinery-like murmur and would not typically present with mottling or pallor. Pulmonic stenosis would present with a systolic ejection murmur at the upper left sternal border, but would not typically cause mottling or pallor of the lower extremities.

A 5-Year-Old Child Has an Elevated Blood Pressure During a Well