Congenital heart diseases have varied presentations depending on the age of presentation. Regression of neonatal pulmonary hypertension and the timing of establishment of left to right shunt determines the onset of symptoms. Pre-tricuspid shunts generally remain asymptomatic during the childhood while large post-tricuspid shunts present with heart failure in late neonatal or early infancy period. Admixture lesions have pathophysiology similar to large post tricuspid shunts with additional small right to left shunt causing mild systemic desaturation. Murmurs are prominent in valvular heart diseases. Careful clinical assessment of features of high pulmonary blood flow, presence of absence of systemic desaturation, status of second heart sound and murmur would help to arrive at a reasonable bedside diagnosis.