While it is certainly possible to hear an apical pulse through a thin T shirt, if you are having trouble simply tell the patient you need to put your stethoscope directly on skin.
When you have to take an apical rate on a large breasted woman, you will have to move the breast in order to get your stethoscope positioned properly against the rib cage.
Use the back of your hand to push the breast gently up and out of the way. It is less “personal” than when using the palm side of your hand. Gloves are not necessary.
If you find it difficult to raise the breast and get an apical rate, place the stethoscope on top of the breast.
It may be higher up than the actual apex of the heart but chances are you will still be able to hear just as well.
Realize that the majority of the heart lies mostly in the center of the chest. It is only the apex that lies on the left side.
Listening at the apex allows you to hear both the atrial and ventricular sounds; Lub-Dub is one beat one complete contraction of top and bottom chambers and the valves.
Notice she forgot to put the side rail back up!! Naughty, naughty!!
When dealing with any cardiac patient, it is best to get an apical pulse rather than a radial one as it will be more accurate. Why? Because there are certain conditions where the heart does not beat efficiently enough.
The contractions of the chambers of the heart may not be strong enough to translate into expanding artery walls all the way down at the wrists.
You will also be able to hear heart murmurs or artificial valves.