The characteristics of four infants with myocarditis who presented to the emergency department with acute onset of severe respiratory distress and shock are presented. Although history and physical findings were not supportive of hypovolemic shock or bronchospasm, three of the four infants received an intravenous fluid bolus, and two were given bronchodilator therapy. All patients had metabolic acidosis, and three had cardio-megaly on chest x-ray. Two patients survived. Initial recognition and stabilization of the pediatric patient with cardiogenic shock secondary to myocarditis is reviewed.