Still struggling with heart sounds

[tsm007]

New nurse, but still struggling with heart sounds. I'm really frustrated. In the beginning of school I thought I'd get better with practice and yet hear I am graduated and licensed and still struggling with it. Auditory discrimination in general is a weak point for me. I have a horrid sense of rhythm. I had major problems marching in step in the military and in marching band. I think this is the root of my problem. I am irritated because I do not want this one thing holding me back, but I constantly feel insecure with my assessments because I am afraid. I feel like everything sounds regular to me. How am I supposed to differentiate between different abnormal heart sounds if I can't even differentiate normal from abnormal very well? I can get the blatantly obvious irregular rhythms. I really, really want to get better at this. I am willing to work on this every day until I master it, but all I seem to be able to find for resources is audio recordings of the different types of abnormal heart sounds. I want some type of quizzer that just starts with differentiating normal from abnormal and works it's way up. I am book smart. I can tell you the pathophysiology on the heart sounds and feel like I can get ECGs, but I need to work on the mechanics of hearing the differences. I have some other assessment skills I want to improve, but this is the one I want to improve on most. Does anyone have any ideas or suggestions for improving this?

[suanna]

I have never in my career had a physician or peer give a hoot about heart sounds. It's nice to be able to say "this patient has a loud pan-systolic murmur that I didn't hear eariler in my shift", but realisticaly, if the patient isn't showing signs of clinical compromise, no one is going to care about thier heart sounds, If they are showing clinical compromise, the medical staff is going to assess by echo, labs, cath, X-ray, EKG, tele rhythm strips, stress test; all with or without anomalous heart sounds.... What you think you hear at thier chest is treated as a bit of quirky trivia.

[JBudd, MSN]

There are youtubes and web sites where you can practice listening, but the biggest thing you really need to hear is regular vs irregular. You can hear if there are missed beats, or rapid then slow then rapid again.

In the ER, I've picked up some murmurs that people are so used to having that they don't report it during the history taking. When I ask they get all embarrassed or laugh about it, while admitting they've had a murmur for years. If it is new, usually it is so loud that there is no mistaking it. For now, just concentrate on rhythm and you'll be fine.