If the blood pressure is elevated in the arms, determination of the blood pressure in the lower extremities is important for ruling out coarctation of the aorta. The patient is asked to lie on the abdomen while the thigh cuff, which is 6 cm wider than the arm cuff, is placed around the posterior aspect of the midthigh. The stethoscope is placed over the artery in the popliteal fossa. The Korotkoff sounds are determined as in the upper extremity. If a thigh cuff is not available, the regular cuff can be applied to the lower leg with the distal border just at the malleoli. The stethoscope is placed over either the posterior tibial or the dorsalis pedis artery, and the auscultatory blood pressure is taken. A leg systolic blood pressure that is lower than that in the arm should raise suspicion of coarctation of the aorta.
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