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Image challenge
Newborn in cardiogenic shock
  1. Franziska Wagner,
  2. Roman A Gebauer,
  3. Christian Paech
  1. Department of Pediatric Cardiology, University of Leipzig, Heart Center, Leipzig, Germany
  1. Correspondence to Dr Franziska Wagner, Department of Pediatric Cardiology, University of Leipzig, Heart Center, Strümpellstr. 39, 04289 Leipzig, Germany; Franziska.Wagner{at}


Clinical introduction A 2-month-old baby boy was referred to our centre due to tachycardia and acute heart failure. The ECG showed a narrow complex tachycardia with a heart rate of 300 beats per minute (Figure 1). Echocardiographically, a patent foramen ovale and a parachute mitral valve with mild regurgitation were diagnosed; cardiac function was highly impaired.

Figure 1

ECG (50 mm/s) showing the small complex tachycardia.

Question Which of the following is the most likely diagnosis?

  1. Ectopic atrial tachycardia

  2. Atrial flutter

  3. Chaotic atrial tachycardia

  4. Focal micro re-entrant tachycardia

  5. Atrial fibrillation


  • electrocardiography
  • supraventricular arrhythmias

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  • Contributors The idea to present our case as an image challenge was originally from CP. As the case was one of our patients, everyone had an easy access to the data but RAG offered the ECGs. FW did the literature search and wrote the article and is also the guarantor. The primary management of the case was done by RAG and CP.

  • Competing interests None declared.

  • Patient consent Guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.