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Most people think it is easy to spot the paediatric emergency – and this usually holds true. However, this is not so in undiagnosed paediatric emergency cardiac disease, as Michele Domico explains. She delves into the practical points on recognising children over one month of age with life threatening cardiac disease. No child comes in and says, “I have chest pain” or in any way alerts the Emergency Department providers to include some type of paediatric heart disease in the differential diagnosis. This talk will review the most commonly missed cardiac “zebras”. Cardiac emergencies can masquerade as anything – fatigue, emesis, tachypnoea, septic shock, failure to thrive and abdominal pain could all point to a cardiac aetiology! Recognition is the key Recognition is the key Michele present five cases of paediatric cardiac emergencies to highlight the subtleties that can exist. Each case provides its own lesion and clinical pearl. A 7-year-old with abdominal pain and fatigue teaches us that a persistently tired