Must be done with a clear understanding of the events of the cardiac cycle, origin and significance of the heart sounds and of murmurs . It must be done in an orderly fashion using both the diaphragm and the bell.
Cardiac auscultation is an important component of the cardiovascular assessment.
To benefit most from this program the participant must understand the mechanical events of the cardiac cycle, and the mechanism of production of the cardiac sounds and of the various murmurs. See the cardiac cycle . I then switch to the bell and listen again at the apex and xiphoid areas for third and fourth heart sounds. S1 is produced by closure of the mitral and the tricuspid valve in that order, and signals the beginning of systole. We perceive S1 as a single sound.