Background: Advances in echocardiographic technology have made a revolution in the quality of image and acquisition of data; however, it has also increased the cost of this diagnostic test. Objective: To determine if chest x ray (CXR) and electrocardiography (ECG) are still valuable in evaluation of new patients with heart murmurs in presence of echocardiography (ECHO). Patients and Methods: This was a six month, prospective clinical study undertaken in the Outpatient Pediatric Cardiology Unit, Zagazig University Children Hospital, between April 2018 and October 2018. The study included 44 patients (boys and girls) between the ages of 1 month and 14 years. All cases were subjected to detailed history, full clinical examination and imaging modalities as CXR, ECG and ECHO. Results: The highest accuracy of CXR was detection of right atrium (96.9%) followed by left ventricle (95.1%). The highest accuracy of ECG was detection of right atrium (98.5%) and left ventricle (95.5%). The agreement between CXR and ECHO in detection of pulmonary hypertension was 0.4 while that for ECG was 0.6. The agreement between CXR and ECHO in diagnosis of congenital heart diseases was 0.6 and that for ECG was 0.9. The accuracy of ECG in diagnosis of congenital heart disease was 95.4% while that for CXR was 70.4%. Conclusion: ECG is more accurate than CXR in detection of cardiac chamber enlargement and heart diseases in general but echocardiography still the most accurate method in this regard. The chest radiograph and electrocardiogram had limited values in the diagnosis of pulmonary pressure changes and echocardiography is the method to be used in this regard.