A 6-month-old male presented with increased respiratory efforts, a low grade fever, O2 saturations in the high 80s and wheezing. Symptoms improved with nebulized albuterol. A chest X-ray revealed cardiomegaly and a right-sided infiltrate (Figs. 1 and 2); EKG revealed criteria consistent with left ventricular hypertrophy (LVH). An echocardiogram confirmed coarctation of the aorta (Fig. 3).