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A pediatric patient with hypoxia or cyanosis can frighten even the most seasoned emergency providers. Patients with these symptoms require immediate evaluation and intervention to stabilize their condition. While the differential can be broad, specific attention must be paid to cardiopulmonary etiologies. Tetralogy of Fallot is the most common cyanotic congenital heart abnormality, and routine screening surprisingly misses a significant amount of these cases. This case serves as an example of a missed diagnosis by screening efforts and reaffirms the resuscitation algorithm of a hypoxic pediatric patient that all emergency providers should be familiar with.

First described in the 1800s, cardiac asthma is defined as wheezing, cough, and orthopnea secondary to left heart failure. The cardiopulmonary interaction forms the basis for the pathophysiology of cardiac asthma-a state in which disease or failure of the former manifests in pathologic findings and symptoms of the latter, the majority of which are reversible with correction of the underlying cardiac pathology. Treatment is generally aimed at primary cardiac disease, as no specific therapies for cardiac asthma itself have been proven effective. More recent research has focused on the molecular biology of the inflammatory reaction and profibrotic state of cardiac and pulmonary remodeling, with transforming growth factor-b and its associated signaling pathways emerging as possible therapeutic targets.