How to Listen for a Third Heart Sound

Are you trying to listen for a third heart sound in a patient?

Is your environment very quiet?

Is the patient's chest fully exposed?

Are you fully attentive and unhurried?

Are you using a high quality stethoscope?

Are you listening with the bell of the stethoscope applied lightly to the chest?

Do you listen with the patient lying on his or her left side if possible?

Do you listen over the apical impulse?

Do you listen over the xyphoid with the patient sitting up and leaning forward if the patient cannot be recumbent?

Do you listen continuously through several heart beats and several breaths?

Do you try maneuvers that increase ventricular filling and stroke volume if needed?