| Summary: | Persistent crying in infants includes a wide range of differential diagnosis,frombenign causes to life-threatening situations. Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA) Syndromeisa rare congenital heart disease that presents as ischemia or heart failure in the first months of life and prompts urgentsurgical treatment. A five-weeks-old infant was taken to the emergency department due to inconsolable crying. Physical examination revealed a mitral systolic murmur. Chest X-ray evidenced cardiomegaly. Electrocardiogram and laboratory exams suggested myocardial ischemia. On echocardiogram he presented dilated left chambers, left ventricular dysfunction, and mitral regurgitation. An aortography was performed showing uncertain origin of theleft coronary artery. A computed tomography angiography confirmed the diagnosis and reimplantation surgery was performed with favorable outcome. Although rare, ALCAPA can result in acute myocardial infarction and sudden death. A high rate of clinical suspicion and a thorough examination are key to diagnosis, treatment and prognosis.
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