Are the arterial pulsations normal?
Is the pulse volume normal or increased?
Is there a discrepancy of pulsation in any of the four extremities?
A careful evaluation of pulsations in all extremities should always be a part of physical examination. Coarctation is readily diagnosed when weak femoral pulsations are detected in comparison to branches or radials. While a four extremity blood pressure measurement should ideally accompany clinical evaluation in all children with suspected heart disease, it is not always feasible.
Nonetheless, when a discrepancy in pulses is suspected, four extremity blood pressure measurements should be obtained. An automated non-invasive blood pressure instrument is preferred over manual recording for four extremity blood pressure measurement.