Best asked on WORD HELP board! nm - Wrong board!

A/P - Linda

Maybe this will help - Janie

If “AP” is really clear, the following may explain it. 

This comes from instructions on how to do the exam, from the UCSD School of Medicine:

Engage the diaphragm of your stethoscope and place it firmly over the 2nd right intercostal space, the region of the aortic valve.  Then move it to the other side of the sternum and listen in the 2nd left intercostal space, the location of the pulmonic valve.  Move down along the sternum and listen over the left 4th intercostal space, the region of the tricuspid valve.  And finally, position the diaphragm over the 4th intercostal space, left midclavicular line to examine the mitral area.  These locations are rough approximations and are generally determined by visual estimation.  In each area, listen specifically for S1 and then S2.  S1 will be loudest over the left 4th intercostal space (mitral/tricuspid valve areas) and S2 along the 2nd R and L intercostal spaces (aortic/pulmonic valve regions).  Note that the time between S1 and S2 is shorter then that between S2 and S1.  This should help you to decide which sound is produced by the closure of the mitral/tricuspid and which by the aortic/pulmonic valves and therefore when systole and diastole occur.  Compare the relative intensities of S1 and S2 in these different areas.

Hope this helped.