Rapid breathing due to cardiac disease is usually not associated with significant retractions and use of accessory muscles. As a general rule, a well-developed neonate who presents with unexplained cyanosis and tachypnea should be suspected of having congenital cardiac disease. In neonates with transposition of the great arteries and ventricular septal defect or critical coarctation of the aorta, congestive cardiac failure may be the presenting feature. Signs of heart failure may be very subtle but are life threatening and require emergency referral.35
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