Distant heart sounds?

[tsm007]

So I bought a spiffy new stethoscope and was testing it out last night because I really struggle sometimes hearing lung sounds. I was so happy with my purchase I could hear lung sounds clear as a bell with it, but no matter where I put the stethoscope I could not hear his heart beating. I listened in odd places too thinking maybe his heart maybe was enlarged. I eventually could hear it, but it was really, really faint and hard to count. So I went digging through his chart to see if there was something up. I'm really trying hard to improve my assessment skills and start connecting the dots when I hear/see something abnormal instead of just charting it. So in his chart two doctors notes that have charted "distant heart sounds" or "distant s1/s2". I did a little reading on it and the nearest I can put together is his history of COPD is the issue. His lung sounds were overpowering his heart sounds. Does this sound right? Does anybody have any tips for hearing these distant heart sounds in cases like this? I don't think he could follow directions very well to exhale for me to listen. I would have really struggled to count his apical pulse, but I could palpate his pulses without a problem. I go back tonight and want to give it another go at hearing it better and looking for some tips. I think I'm on the right track with his COPD being the issue. They were not muffled. I think this is a chronic problem. He is not overweight.

[Purple_roses]

I would be interested in this explanation as well. There was one day during clinical (about a month ago) when the nurse asked me to get vitals on a patient I'd never worked with. I could not hear his AP. I listened for several minutes and tried several areas for stethoscope placement. The only cardiac landmark I could even remotely hear was the Aortic, and I couldn't even hear it well enough to count.

[Lev, MSN, RN, NP]

If they are very fleshy in the front, try listening to their back.

When I think of distant heart sounds I think of fluid and fat.

ETA: telling patients to hold their breath helps sometimes to prevent the lungs sounds from getting mixed in.

[HeatherArizona]

When you are having trouble hearing heart sounds there are a few things you can do. Listening from the back if your patient is obese, asking them to hold their breath if their lung sounds are loud, having the patient raise their arms above their head, or having them lean forward slightly might help. Distant heart sounds means you can't hear the sounds well. This is usually because there is a greater than average distance between the chest wall and the heart. This distance can be created by fat/obesity or air/lung disease. Do not confuse muffled heart sounds with distant heart sounds as the etiologies are very different.  Distant heart sounds are often benign where as muffled heart sounds are not. Pericardial and pleural effusions are the two most common causes of muffled heart sounds.

Happy listening. Also, if your budget allows, an amplified electronic stethoscope is wonderful for auscultating heart, lung, and abdominal sounds. 

[HiddenAngels]

I am cacklinggggg?.  What’s the point of this spiffy stethoscope if you can’t hear the heart!  Ha ha ha!

or maybe perhaps the pt has dextrocardia.. ? 
 

 

[chare]

3 hours ago, HiddenAngels said:

I am cacklinggggg?.  What’s the point of this spiffy stethoscope if you can’t hear the heart!  Ha ha ha!

[...]

Not a very helpful response, even considering that this thread had been dead for nearly 7 years when it was resurrected.

ETA: Based on the initial post this was most likely a newer nurse learning heart sounds that had come here looking for tips.

3 hours ago, HiddenAngels said:

[...]

or maybe perhaps the pt has dextrocardia.. ? 

As this is so common (insert sarcastic font) and the OP reviewed the chart for potential causes, I would imagine, if this were the case it would have been documented.