ECGs in the ED
The physical exam reveals a robust, well-nourished, mildly cyanotic baby in no respiratory distress. Pulse oximetry in room air is 86%. The heart rate is 140 bpm, the respiratory rate is 38 per minute, and the blood pressure is 86/42. The baby is well hydrated with cyanosis notable on the lips and oral mucous membranes. The remainder of the head and neck exam is unremarkable. The chest is clear to auscultation. The cardiac exam is significant for an increased right ventricular impulse, a normal first heart sound and a narrowly spit second heart sound. There is no gallop. There is a 3/6 harsh high-frequency systolic ejection murmur at the left sternal border that radiates to the back and axillae. The pulses are full and equal. There is no hepatomegaly. The extremities are warm despite the cyanosis. The neurologic exam is nonfocal.
An electrocardiogram was performed (Figure 1).