A "loving and caring" four-year-old boy died after suffering a heart attack, after struggling to breathe earlier that day.

George Spencer, from Clitheroe, died on March 19, 2021, from myocarditis having had issues with his breathing earlier that day from croup (an upper airway infection), however, it was misdiagnosed.

Speaking at the time of his death, his family said: "George was very loving, caring, funny and always willing to give lots of hugs and kisses, ‘1,000 kisses’ he would say.

"He was happiest playing outdoors in the woods or by the river with his twin brother, Arthur.

"He was liked and loved by everybody who met him.”

He was running around in school earlier that day and teachers had noted that he was struggling with his breathing and sitting down on occasions.

His father took him to the doctors for an emergency appointment, as the twins had both struggled on several occasions with croup, and the family believed George had contracted the infection again.

The GP, Dr Jill Osgood from Castle Medical Group, observed and diagnosed George with an upper respiratory tract infection, saying she did not think that he had croup.

She said: “He did have noisy breathing, but it didn’t sound like croup.

“It was more nasal breathing therefore in my opinion, no steroids were needed.”

She agreed to prescribe an inhaler but just two hours later, George’s condition suddenly changed.

George collapsed and had a heart attack. A neighbour ran to a local school and got a defibrillator and put it on George while also administering CPR.

An ambulance was called and paramedics told medics at Royal Blackburn Hospital that they were on their way with George.

By the time they arrived at the hospital, CPR had been ongoing for 40 minutes.

Dr Peter Fitzmorris, a paediatric consultant at the hospital, went and spoke with his parents to tell them George had died and that they would have to stop performing CPR.

During the post-mortem examination, it was discovered George had died from myocarditis – an illness with minimal symptoms that causes inflammation of the heart.

It was also noted George had four infections, including croup.

Dr Fitzmorris was asked whether the croup would have impacted George and along with the myocarditis could have caused his death.

He said: “It might be, it might not be. I don’t think you can say either way.

“I think that the croup contributed to the fact there was an arrhythmia that night, but I can’t say 100 per cent it definitely contributed.

“He could have had a cardiac arrest that night without the croup.

“If the cardiomyopathy would have progressed, even with help or a heart transplant he could have passed away even if the croup had not been around.”

Asking whether the myocarditis could have been diagnosed by her that day, Dr Osgood added: “I think it can be difficult to recognise, I don’t think it can always be recognised.”

Coroner Richard Taylor said March 19 should have been a "normal day" for the family but tragically, it was not.

In returning a narrative conclusion, he said: “George Thomas Spencer died on March 19, 2021, at the Royal Blackburn Hospital from an inflammation of his heart to which, more likely than not, a contributing factor was an undiagnosed infection.”