At the end of the case the learner should be able

• To appreciate the differences between adult and pediatric cardiovascular physical exam. 
• To describe and differentiate innocent and pathologic murmurs 
• To list common symptoms and signs associated with pathological murmurs 
• To determine what follow-up investigations should be ordered 
• To describe and differentiate acyanotic and cyanotic lesions

Aaron is a 6-month old boy who has come to your preceptor’s family medicine clinic for a well child assessment. He appears comfortable at rest with no obvious signs of distress. Your preceptor asks you to conduct a physical examination.

While conducting the cardiovascular exam, you remember that the beating heart of a baby can differ from that of an adult in a number of different ways.

Which of the following are major differences found on the cardiovascular physical exam between children and adults? (Choose all that are appropriate)