1. Listen with the diaphragm at the right and then left 2^nd interspace near the sternum (aortic and pulmonary areas)
    
2. Listen with the diaphragm at the left 3^rd, 4^th, and 5^th interspaces near the sternum (tricuspid area)
    
3. Listen with the diaphragm at the apex (PMI) (mitral area)
    
4. Listen with the bell at the apex
    
5. Listen with the bell at the left 4^th and 5^th interspace near the sternum
   
6. Have the patient roll on their left side.
   • Listen with the bell at the apex.
   • This position brings out S3 and mitral murmurs.
      
7. Have the patient sit up, lean forward, and hold their breath in exhalation
   • Listen with the diaphragm at the right and left 2^nd, 3^rd and 4^th interspace near the sternum.
   • This position brings out aortic and pulmonary murmurs.
      
8. Record S1, S2, (S3), (S4), as well as the grade and configuration of any murmurs

Diagram of where to place the stethoscope