Which cardiac anomaly could explain upper body hypertension and lower body hypotension?

Coarctation of the aorta is a condition characterized by the narrowing of the aorta, typically occurring just distal to the left subclavian artery. This anatomical abnormality leads to differential blood flow patterns: it can cause hypertension in the upper body and hypotension in the lower body.

In this situation, the upper body receives normal or increased blood flow due to the proximity of the coarctation to the arteries supplying the arms and head. As a result, blood pressure measurements in the arms may be significantly elevated. Conversely, the narrowing reduces blood flow to the lower body, resulting in decreased blood pressure in the legs and lower trunk.

This imbalance in systemic blood pressure helps to explain the observed symptoms. Coarctation of the aorta is known for its distinctive presentation in clinical scenarios, where you can palpate pulses stronger in the upper limbs compared to the lower limbs or assess discrepancies in blood pressure readings between them.

Other cardiac anomalies listed do not typically exhibit this pattern of upper body hypertension combined with lower body hypotension, making coarctation of the aorta the best explanation for these clinical findings.