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Patient: Female, 6-month-old Final Diagnosis: Anomalous left coronary artery from the pulmonary artery (ALCAPA) Symptoms: Dyspnea • failure to thrive • feeding problems Medication: — Clinical Procedure: Ultrasound Specialty: Cardiology Objective: Rare disease Background: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare anomaly. When present it can result in failure to thrive and congestive heart failure. Case Report: We present the case of a 6-month old female whose presentation was one of failure to thrive. Point of care ultrasound and electrocardiogram (ECG) were used to diagnose heart failure with consideration of ALCAPA. These tools helped to expedite transfer to a tertiary care center for definitive therapy. Conclusions: Although a rare anomaly, ALCAPA induced heart failure can be quickly identified on bedside ultrasound. Together with ECG findings, the Emergency Physician can expedite the diagnosis and proper disposition.