The examiner should be on the right side of the patient while the patient lies flat on the back. If not already at the proper height, the bed should be adjusted so that the examiner is comfortable. The examiner should listen in the aortic, pulmonic, tricuspid, and mitral areas. However, the examiner should not limit auscultation to these areas alone. The examiner should start at any area and move the stethoscope gradually over the precordium from area to area. The areas have been established to provide some degree of standardization.
While listening at the apex and left lower sternal border with the bell, the examiner should determine whether an S3 or an S4 is present.
Cardiac murmurs may radiate widely. The examiner should determine where the sounds are loudest or best heard. There are no acoustic walls in the chest. A murmur typically heard at the apex with radiation to the axilla may be heard in the neck, if it is loud enough. The murmur in this example is probably loudest at the apex and axilla.
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