What should you do if you are having difficulty hearing heart sounds in a patient with emphysema?

In patients with emphysema, the increased air trapping and hyperinflation of the lungs can significantly obstruct the transmission of heart sounds during auscultation. Listening in the epigastrium can be beneficial as heart sounds may be more audible in that region due to their proximity to the diaphragm and the heart itself, minimizing the interference caused by over-inflated lungs.

Utilizing this technique can help ensure that the clinician captures heart sounds that might otherwise be muted in the chest area. Adjusting the patient's position can also assist in improving the auscultatory quality, but focusing specifically on the epigastric region is a targeted strategy that is particularly useful in this scenario, leveraging anatomical considerations to enhance sound transmission from the heart.