Aortic coarctation is an uncommon etiology for adult-onset hypertension. Fe
w cases in the modern literature have been reported with lower thoracic aor
tic coarctation as a cause for hypertension. A 36-year-old woman who had be
en treated for 12 years with progressive hypertension presented to her loca
l emergency room with worsening dyspnea on exertion and acute onset of left
-sided chest and upper limb pain. Evaluation for myocardial infarction was
negative; however an echocardiogram revealed concentric left ventricular hy
pertrophy with severe global dyskinesia and an ejection fraction of 35%. Ca
rdiac catheterization and aortography identified a lower thoracic aortic co
arctation with a 90 mm Hg gradient and mild abnormalities of the coronary a
rteries. There was no evidence of involvement of the visceral or renal arte
ries. After stabilization of her blood pressure with nipride, nitroglycerin
, and esmolol, she underwent a left posterolateral thoracotomy for aortic r
epair using an interposition Dacron graft. Operative findings showed no evi
dence of arteritis. Pathologic examination of a removed portion of the aort
a revealed severe calcific atherosclerotic vascular disease and fibrosis in
the adventitia with no evidence of active inflammation The patient was qui
ckly weaned from intravenous antihypertensive medication postoperatively an
d eventually discharged after a normal convalescence with diminished hypert
ension.