Pediatric Heart Sounds Murmurs

When To Refer

pediatric auscultation image

About This Course

The objective of this course is to apply your auscultation skills for pediatric referrals cases. Each case consists of multiple pages which present the patient's history, a virtual manikin page for heart sounds and a clinical findings page. After completing a case including correctly answering all questions, that case will be marked as completed in the table of contents.

Remember that pediatric murmurs can be a normal part of development. Not all murmurs need treatment.

Cardinal Clinical Signs

There are six cardinal clinical signs on cardiac examination which prove to be significant independent predictors of the presence of a confirmed cardiac lesion. The six signs are the following:

  1. A murmur of intensity 3 or greater.
  2. The murmur is best heard at LUSB (2LICS).
  3. The murmur is of harsh quality.
  4. The murmur is pansystolic.
  5. The presence of a systolic click.
  6. The presence of an abnormal second heart sound (fixed splitting with respiration).

Course Completion Certificate

Upon completing all cases within this course (during one session), you will be able to print a course completion certificate.


Please use good quality headphones or earphones while listening to heart sounds during this course.

Begin Course


Cardinal Clinical Signs in the Differentiation of Heart Murmurs in Children
Brian W. McCrindle MD,MPH, et. al.
Archives of Pediatric Adolescent Medicine. 1996;150:169-174

External Links

Wikipedia article
National Institutes of Health on Heart Murmurs