● Time the murmur—is it in systole or diastole? What is its duration?

● Locate where on the precordium the murmur is loudest—at the base, along the sternal border, at the apex? Does it radiate?

● Conduct any necessary maneuvers, such as having the patient lean forward and exhale or turn to the left lateral decubitus position.

● Determine the shape of the murmur—for example, is it crescendo or decrescendo, is it holosystolic?

● Grade the intensity of the murmur from 1 to 6, and determine its pitch and quality.

● Identify associated features such as the quality of S1 and S2, the presence of extra sounds such as S3, S4, or an OS, or the presence of additional murmurs.

● Be sure you are listening in a quiet room!

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