Heart sounds with large breasts

rubato, ASN, RN · May 22, 2012

I was curious about this as well. In my CNA class, I was always partnered with the largest student. She was very overweight, and I struggled finding any vitals on her. I also have a horribly cheap stethoscope, so I may need to upgrade before I start my RN program this fall.

classicdame, MSN, EdD · May 22, 2012

the heart is between the breasts and you can move tissue around, just like you would move an arm to get BP. Also, you can hear the heart from the back to some degree. Practice will improve your confidence.

Catzilla · May 22, 2012

My breasts are pretty big and I can hear my patient's heart sounds just fine! :lol2:

GitanoRN, BSN, MSN, RN · May 22, 2012

on this issue, i recall my first week straight from nursing school i received an admission and i needed to check her vitals, the first thing she said to me was "just move the girls out of the way" i tried to keep a straight face this lady made dolly parton look look like a 8yr girl. therefore, once again i was trying to get to the apex when she reached with both hands and flopped the breast over her shoulder which made a loud sound almost like a slap on the face, we both got the giggles but shortly thereafter i could hear the clearest heart rhythm sound. needless to say, from there on i learned to ask any endowed female to maneuver their own breast.

chevyv, BSN, RN · May 22, 2012

Move them girls up and get your steth under that wire! Lol. I still close my eyes and listen. Keep your fingers off the back part of your steth while listening as well. Those fingers can be heard brushing up against the fabric way too easily.

I've never had a pt upset with me because I rearrange the breast tissue a bit. I'm a larger busted gal myself and can care less if you have to move me around a bit to hear better. Take your time and it really does help to have a decent steth. I've placed mine under the wire of bras and have no problem. Once your out in the field, you're really not sitting in that spot too long, but accuracy is important. Honestly, I still can't pick up murmurs which is why I close my eyes. I can concentrate better that way. It kind of shuts out anything else thats going on around me. Keep on practicing and soon you'll be just fine.

knighton201 · May 22, 2012

describe what you're going to do to the lady before touching (less backhands this way gentlemen), then lift and apologize

great suggestion about asking your patient to help, will have to remember to try that one

KatieMI, BSN, MSN, RN · May 22, 2012

1) Get a good stetoscope. Not necessary $100 Littmann, but not that Sprague nonsence either. Allheart.com has some of their own for like $20 or less, of quite acceptable quality.

2). If client is supine: her left hand goes up and behind the head as much as possible to displace the breast to the up, then put the stetoscope 4 fingerbreaths to the left of the sternum right at the lower breast crease or a bit below it and ask/assist her to turn onto her left side sligtly. If you still cannot hear/feel, move stetoscope further to the left and ask her to exhale.

3). If client is sitting: same with left hand, then lean her forward and ask to exhale. She may use hands to support herself over your shoulders if she feels unstable in this position.

Human heart is hanging, quite literally, from that bunch of vessels and nerves, and surrounded by aerated lung tissue and fat. It has some small freedom of movement. The idea is to position a client so that the heart will move forward, close to the anterior chest wall.

tsm007 · May 22, 2012

on this issue, i recall my first week straight from nursing school i received an admission and i needed to check her vitals, the first thing she said to me was "just move the girls out of the way" i tried to keep a straight face this lady made dolly parton look look like a 8yr girl. therefore, once again i was trying to get to the apex when she reached with both hands and flopped the breast over her shoulder which made a loud sound almost like a slap on the face, we both got the giggles but shortly thereafter i could hear the clearest heart rhythm sound. needless to say, from there on i learned to ask any endowed female to maneuver their own breast.

i really like this idea! i am going to try this next time i do an assessment and see if this helps. i bet it does. i am sure as long as you use correct terminology and are professional that would be a good approach.

Shorty11, BSN, RN · May 23, 2012

Like a previous poster said, ditch the underwire bras for clinicals! At my school, all the ladies wear sports bras to help each other out when practicing auscultating heart sounds. See if your partner or whoever you are practicing on would be willing to wear a sports bra while at clinicals so it will be easier for you to maneuver (or for her to maneuver) her large breasts out of the way. Modesty is of course important, so I would first ask her to move her breast out of the way or let her know that you will be moving her breast as to make it easier to find the apex/PMI. Don't act nervous and it will put the person more at ease. Like "you do this all the time" kinda thing.

grownuprosie · May 23, 2012

Go right under the middle of the bra...should be able to hit the apex just fine :)

Isn't that the sternum?

Shorty11, BSN, RN · May 23, 2012

Must have meant right under the middle of the CUP of the bra?

grownuprosie · May 23, 2012

ah. you are right, Shorty11.