Cardiac-related Syndromes that Mimic Ischemia in the Pediatric ECG

Frank A. Paul, DO, FACOEP, FACEP, Emergency Medicine Residency Director, Kingman Regional Medical Center, Kingman, Ariz; Eileen M. Pokriefka, DO, FAAP, Vice Chairman, Department of Pediatrics, Mount Clemens General Hospital, Mount Clemens, Mich; Craig R. Wallingford, DO, FACOFP, Program Director, Family Practice Residency, University of New England, College of Osteopathic Medicine, Biddeford, Me Joanne Mozuras, MS, CNM, Clinical Practice, New Haven Medical Center, New Haven, Mich

A1-day-old newborn is observed to have tachycardia and tachypnea and is feeding poorly. Physical examination is normal, except for a grade 4/6 pansystolic ejection murmur, best heard over the left lower-sternal border. The following electrocardiogram (ECG) is obtained (Figure).

How would you interpret this ECG?

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