Congenital heart disease isn't just diagnosed in the antenatal period and during post-natal examination. Nick Pigott takes us through the three main presentations of congenital heart disease (shock, cyanosis and heart failure) and reassures us that treating these patients is simpler than we think, urging us to consider cardiac disease in the sick newborn. He covers duct-dependent lesions, structural obstructive lesions, immediate resuscitation, the usefulness of physical examination, a deeper dive into hyperplastic left heart syndrome, the known cardiac patients (and what to do with them) and the paediatric cardiology wonder-drug: Prostaglandin infusion.