A neonate has recurrent attacks of abdominal pain, restless irritability and diaphoresis on feeding. Cardiac auscultation reveals a nonspecific murmur. He is believed to be at risk for Mi. Likely diagnosis here is -

Ans. is 'd' i.e., Anomalous coronary aery Anomalous origin of coronary aeries o There is anomalous origin of the left coronary aery from the pulmonary aery : In this anomaly the blood supply of the left ventricular myocardium is severely compromised. Soon after bih (Neonate) as the pulmonary aerial pressure falls, perfusion pressure to the left coronary aery becomes inadequate. Myocardial infarction and fibrosis may result. Clinical manifestion : Congestive hea failure becomes manifest within first few month of life and is often precipitated by respiratory infection. Recurrent attacks of discomfot, restlessness, irritability, diaphoresis, dyspnea and pallar with or without cyanosis occur - could be caused by angina pectoris. Cardiac enlargement is moderate to massive o Murmurs may be present.