The most common symptom of hea failure is tachypnea with grunting, gasping breathing, or breathlessness with feeding. A respiratory rate consistently above 60 is seen. Poor weight gain from diminished intake and increased work of breathing is the rule. Cool, moist skin; a diminished and rapid aerial pulse; and hepatic enlargement are common accompanying signs. Ref: Brown D.W., Fulton D.R. (2011). Chapter 83. Congenital Hea Disease in Children and Adolescents. In V. Fuster, R.A. Walsh, R.A. Harrington (Eds), Hurst's The Hea, 13e.