There are several pediatric cardiac disease processes that get misdiagnosed because they present with other symptoms. No child comes in and says, “I have chest pain” or in any way alerts the Emergency Department providers to include some type of pediatric heart disease in the differential diagnosis. This talk will review the most commonly missed cardiac “zebras,” but that is not all. The presentation is meant to provide you with some helpful hints for when it is time to stray from the straight path and start entertaining a cardiac diagnosis in a sea of children complaining of respiratory, gastrointestinal and other symptoms.