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Heart murmur evaluation is the most common cause of referral to cardiology, and auscultation of heart sounds with a stethoscope remains a key component of the initial cardiovascular exam. Adoption of telecardiology has been limited by challenges in teleauscultation. We set out to compare in-person auscultatory findings with heart sounds recorded by the Core stethoscope (Eko, Berkeley, CA) in patients with normal heart sounds, innocent heart murmurs, and a variety of pathologic findings. Our study demonstrates that Eko recordings had a high percent of agreement with in-person auscultation findings and echocardiogram findings, with moderate inter-rater reliability. It was useful in identifying patients with pathologic murmurs who would benefit from further assessment. It was able to discern major types of pathological murmurs. Certain qualitative differences in the recorded sounds as compared to in-person auscultation were identified by the reading cardiologists. They were able to acclimate to these subtle differences. The system was felt to be easy to use, and most cardiologists in the study would consider using it in clinical settings. The Eko Core system may be a useful screening tool for murmur evaluation. [ABSTRACT FROM AUTHOR]