so when I am instructing the patient about what I'm planning to do I don't want to use any medical terms so I'm simply going to tell them that I'm going to be listening to their heart and four spaces and then I show that on my own body I say I'm going to be listening here here a little lower than that and then on the left chest wall so just a second and I'll show you how to do that on a male volunteer listening post is the aortic valve and that is on the right sternal border at the second intercostal space so assuming that his first rib is just posterior to the clavicle I will take this is the first intercostal space and there is the second intercostal space I'm going to go over until I'm just at the sternal border which is right here and then I'm going to listen directly across at the second intercostal space on the left this is the pulmonic valve as we go down so that is the second intercostal space third intercostal space fourth intercostal space the fourth intercostal space on the left of the sternum is where we find the tricuspid valve finally in the midclavicular line so halfway across the clavicle and coming down in the fifth intercostal space which is about right here on him I will listen to the mitral valve a or tack listening-posts second intercostal space just to the right of the sternum pulmonic listening-posts second intercostal space just to the left of the sternum tricuspid listening spot post fourth intercostal space just to the left of the sternum and then midclavicular line fifth intercostal space for the mitral valve thank you for the female patient we listen to the same valves but of course the left breast can be in the way of our effectively listening to the mitral valve for this reason we ask our patients to assist us so please watch as I demonstrate how to oskol take the four heart valves on a female patient so I'm going to listen to four spots on your chest right here right here a little lower than that and then on your chest wall itself left chest wall so to get started would you mind if I undid your gown so that I can listen on skin no that's a and I'm gonna pull it down and I just like for you to support it there you go thank you so clavicle first intercostal space second intercostal space and then I listened to the pulmonic valve directly opposite that and I do need to lower this just a little bit tricuspid valve okay now you can put this up and for the fourth valve I'm going to ask you to lift your left breast with your right hand okay and I'm going to come in oh this and the the side of your gown and I'm gonna place the stethoscope in the midclavicular line fifth intercostal space or as close to the fifth intercostal space as I can get while preserving my patients modesty okay thank you very much please note that once I have the hang of this I don't really have to count down the intercostal spaces so you may be wise to practice this at home before your SP encounters so that you can simply look at your patient and guesstimate where the second intercostal space is on the right and the left go down a little bit to get the fourth intercostal space and then the fifth intercostal space thank you very much