Supraventricular Tachycardia in an Infant: Easy Peasy or the Devil in Disguise?: A Case Report of an Anomalous Presentation of a Coronary Anomaly

All articles of this category (opens in new window) Background: Supraventricular tachycardia (SVT; with a prevalence of approximately [2.5:1,000]) is not an uncommon phenomenon in newborns and children. In contrast, “Anomalous Left Coronary Artery from the Pulmonary Artery” (ALCAPA) is a rare condition with an incidence of 1 in 30,000 live births, or 0.25 to 0.5% of all congenital heart defects. We report a case of an unusual presentation of a patient with ALCAPA. Methods: A 2.5-month-old girl was transferred from a pediatric hospital to our tertiary heart center due to restlessness, decreased feeding, tachypnea, and tachycardia. Upon arrival, the child was in reduced but apparently relatively stable condition. The electrocardiogram (ECG) showed signs of supraventricular tachycardia (SVT) with a heart rate of 240/minute, without evidence of ischemia. Echocardiography revealed global reduced biventricular function, without regional wall motion abnormalities and severe tricuspid- and mitral valve regurgitation. Due to a high heart rate, the visualization of the coronary arteries was impaired. Cardioversion into sinus rhythm was achieved via adenosine, followed by initiation of oral propafenone anti-arrhythmic therapy. Due to persistent (sinus-) tachycardia, therapy was timely escalated with additional propranolol. Not long thereafter, following cardioversion of SVT relapse, the girl required cardio-pulmonary resuscitation due to asystole. In the thorough postresuscitation work-up, the ECG displayed, again, no evidence of ischemia. However, during echocardiography, suspicion was raised of an anomalous origin of the left coronary artery from the pulmonary artery. The diagnosis was confirmed in a coronary angiography. The patient subsequently underwent surgical coronary re-implantation using a tunneling technique. Conclusion: Anomalies may present anomalous. Excluding coronary abnormalities is crucial in any patient with impaired cardiac function! This is regardless of an apparently normal ECG and has to be considered even in the presence of a plausible working hypothesis with higher probability. Although this is common knowledge in pediatric cardiology, sometimes we are reminded the hard way. “The devil comes in many forms,” and in this case, we were deceived by the differential diagnosis of a tachycardia-induced cardiomyopathy. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany