This important, reversible cause of hypertension is simple to diagnose, and every new case of hypertension should be screened for it. The most reliable diagnostic technique is to place the thumb of one hand on the brachial pulse and the other on the femoral pulse, and assess them simultaneously. Normally, these pulses are equal in volume and timing. A delay in the femoral impulse, or a reduction or absence of this pulse in a young person, strongly supports the diagnosis of coarctation. Other suggestive features include a vigorous pulsation in the suprasternal notch and a systolic murmur under the left clavicle. Occasionally, a continuous murmur can be heard between the scapulae, signifying collateral circulation via intercostal arteries.