Do you actually know how to listen to heart sounds?

[watermen]

Just to ask all third years here, do you all really know how to differentiate the different kind of heart sounds?

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[Samoa]

OK, I'm a 4th year, but by this point in 3rd year, the answer was yes. Not sure I still can, seeing as I haven't picked up a stethoscope in over 4 months, but at one point I was pretty good at it.

 

[Richie Truxillo]

Yes. I was lucky and got an excellent family medicine I rotation at the beginning. It took me about a month to really get the hang of it (I was wanting to call everything a murmur at first LOL) but it's really about practice and seeing some pathology.

After a month of family med or internal med, you'll be spotting a.fib in no time!

 

[Medpilot]

Only the really loud blowing murmurs so far, but it's getting easier.

 

[ocean11]

I am so glad someone posted this...

I have only done psych and ObGyn this far and feel that I still am not comfortable detecting any cardiac abnormality. I know what a 'normal' heart sounds like, but give me a murmer and I'm lost!!! 🙁 hope this improves after FM and IM!

 

[Anka]

My school has an excellent physical diagnosis component to our IM block, which got me from "I guess I hear something wierd" to "I hear a 2/6 systolic murmur radiating to the axilla consistent with mitral regurgitation." I also listened to a bunch of cardiac surgery patients -- they tend to have the more dramatic valvular lesions so you can hear everything (sometimes multiple on the same patient). But, no, after OB/gyn and psych I couldn't hear any of that. It was like ten months into my clerkships that everything clicked.

Best,
Anka

 

[Rendar5]

I was spotting 2/6 and 1/6 murmurs in pediatric patients with some inconssitency. Not hearing anything on surgery, but then it's hard w/ the patients lying down all the time.

 

[QuinnB]

It's pretty tough in the beginning, but just keep listening to as many people as possible. Eventually it becomes a lot easier. Some arrhythmias (PVCs, Afib especially) you can actually pick up by checking the patient's pulse.

 

[deleted109597]

Easiest way to tell the murmur type is to hold the scope on the patient, and feel their pulse with the other hand. Then you have systolic vs diastolic. Rule #1, all diastolic murmurs are bad. Rule #2, this also works for S4 vs S3.
Then you can determine the position of it by holding your scope in the 4 known auscultation sites, and then add the carotids to that.
The only way to get better is to be sure and listen to everyone that has a known murmur when on rounds. The websites just don't do it.

 

[Paws]

Easiest way to tell the murmur type is to hold the scope on the patient, and feel their pulse with the other hand. Then you have systolic vs diastolic. Rule #1, all diastolic murmurs are bad. Rule #2, this also works for S4 vs S3.
Then you can determine the position of it by holding your scope in the 4 known auscultation sites, and then add the carotids to that.
The only way to get better is to be sure and listen to everyone that has a known murmur when on rounds. The websites just don't do it.

I do this too, use the radial pulse to guide my listening. I figure, if I take my time and close my eyes and concentrate, I can start to pick out different tones/whooshes/or whatever. I am trying to be more aggressive about this as well, and I make myself take some time. I tell patients: as a student, I want to learn it well and so I take some time to really listen. Most patients kind of like that, and so they say something like - of course, listen as long as you need! It's only 10 or 20 seconds more or so but it helps me to build my mental heart beat library.

 

[NDESTRUKT]

Agree with the above. Listen with the hand on a radial pulse. Do it for as long as you need. Review that one sheet in First Aid for the Boards on murmurs - it's quick and handy. You'll be fine!

 

[Ceez]

I've always felt that if you can't pick up a Graham-Steele murmur by the end of your first semester of med school you aren't fit to be a doctor

 

[jvencius]

Hehehehehe--this isn't terribly relevant but I thought it's amusing enough to bring up. When I started EMT-P school, I bought a Littman Master Cardio since that's what a buddy recommended (he's got a bit of hearing loss and he needs the MC to hear, well, anything...). Turns out that the MC is so danged sensitive, that in the back of the bus going down the road, pretty much every heart or lung sound rather closely resembles the sound of a Ford Powerstroke diesel engine...😱 In the ER, it was nice since there wasn't nearly as much background noise, but for working in the back of the bus I bought a $10 eBay special that worked perfectly well.

 

[noncestvrai]

I was lucky to hear my share of MMs, but it's never "easy". I was fortunate to have a few PDAs on my NICU stay, interesting sometimes that 1/6 MMs may be in the more significant PDAs! I even called some the fellow did not hear. I think being systematic and timing the lub-dub is key, and when I find it difficult to hear, I close my eyes, and just concentrate. Don't stress about the position LLSB et al...not an exact science.

Another advice, don't listen over the gown, you hear a buch of artifacts.

You can also order a heart echo if you're worried...

Oh, and good advice on the irregularly irregular peripheral pulse in the preceding posts 😉

noncestvrai

 

[babyruth]

I am so glad someone posted this...

I have only done psych and ObGyn this far and feel that I still am not comfortable detecting any cardiac abnormality. I know what a 'normal' heart sounds like, but give me a murmer and I'm lost!!! 🙁 hope this improves after FM and IM!

Listen for those physiologic murmurs in pregos because they are usually pretty good/easier to hear.