Congenital heart disease is the most common of all congenital malformations, affecting nearly 10 in every 1000 newborns. [1] Despite advances in prenatal and newborn screening, patients may still present undiagnosed to ED. This is because the heart is transitioning from the foetal to neonatal circulation.

Presentations range from life-threatening shock or cyanosis in a neonate to respiratory distress, congestive cardiac failure (CCF) and failure-to-thrive in infants. As 80-85% of patients with CHD now survive to adulthood (Best et al, 2016), patients can also present later in life with complex needs. 

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