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A four and a half-year-old white male patient weighing 14 kg was admitted for a physical examination. The patient complained of tiredness after moderate effort over the previous seven months and had been hospitalized with pneumonia on two occasions. He was in a good general state with a rosy complexion and acyanotic. The thorax presented with left anterior bulging, palpable ictus cordis with fremitis at the fifth intercostal space, fixed split S2, systolic murmur of +++/6, ejective at the left sternal border. The lungs had a symmetrical vesicular murmur without adventitious sounds. No alterations were evidenced in the abdomen and the peripheral pulses were palpable and symmetrical. ELECTROCARDIOGRAMThe electrocardiogram evidenced sinusal rhythm with a heart rate of 145 beats/minute and electrical axis of the QRS complex

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