Position the diaphragm on the left upper part of the chest where the 4th to 6th ribs meet, almost directly under the breast. Hold the stethoscope between your pointer and middle fingers and apply enough gentle pressure so that you don’t hear your fingers rubbing together. Ask the patient to relax and breathe normally. You should hear the normal sounds of the human heart, which sound like “lub-dub.” These sounds are also called systolic and diastolic. Systolic is the “lub” sound and diastolic is the “dub” sound.  The “lub,” or systolic, sound happens when the mitral and tricuspid valves of the heart close. The “dub,” or diastolic, sound happens when the aortic and pulmonic valves close. The normal resting heart rate for adults and children over 10 years old is between 60-100 beats per minute. For well-trained athletes, the normal resting heart rate may only be between 40-60 beats per minute. There are several different ranges of resting heart rates to consider for patients under 10 years old. Those ranges include: Newborns up to one month old: 70-190 beats per minute Infants 1 - 11 months old: 80 - 160 beats per minute Children 1 - 2 years old: 80 - 130 beats per minute Children 3 - 4 years old: 80 - 120 beats per minute Children 5 - 6 years old: 75 - 115 beats per minute Children 7 - 9 years old: 70 - 110 beats per minute As you count the heartbeats, you should also listen for any abnormal sounds. Anything that does not sound like lub-dub may be considered abnormal. If you hear anything abnormal, your patient may need further evaluation by a doctor.  If you hear a whooshing sound or a sound that is more like “lub...shhh...dub,” your patient might have a heart murmur. A heart murmur is blood rushing quickly through the valves. Many people have what are called “innocent” heart murmurs. But some heart murmurs do point to issues with heart valves, so you should advise your patient to see a doctor if you detect a heart murmur.  If you hear a third heart sound that is like a low frequency vibration, your patient might have a ventricular defect. This third heart sound is referred to as S3 or a ventricular gallop. Advise the patient to see a doctor if you hear a third heart sound.  Try listening to samples of normal and abnormal heart sounds to help you determine if what you are hearing is normal.
Hold the diaphragm over the patient’s heart. Listen to the heart for a full minute. Count the number of heartbeats you hear in a minute. Listen for abnormal heart sounds.
Hold the diaphragm over the patient’s heart. Listen to the heart for a full minute. Count the number of heartbeats you hear in a minute. Listen for abnormal heart sounds.