Heart Murmur Mnemonic: Simple Tricks For Tricky Sounds

Ewell Mosciski 19 Aug 2025

Do you ever feel like you are juggling a hundred different facts when it comes to heart murmurs? It is a common feeling, you know. One moment, the various sounds and their meanings seem perfectly clear in your head, then a few weeks go by without a quick look, and suddenly, everything just gets all jumbled up again. That can be quite frustrating, can't it? Many people studying or working in healthcare share this exact struggle, wondering how to keep it all straight.

The good news is that you are certainly not alone in this. Remembering the specific characteristics of each cardiac murmur, what they mean, and how they change with different body maneuvers can be a real mental workout. It often feels like a puzzle with too many pieces, and sometimes, too it's almost as if the pieces keep changing shape.

That's where a really good mnemonic comes into play. These clever memory aids can make a world of difference, helping you to lock in those details so they stay put, even when you haven't reviewed them for a little while. This guide will walk you through some easy ways to remember everything important about cardiac murmurs and the maneuvers that affect them, helping you feel much more confident.

The Challenge of Cardiac Murmurs
Understanding Systolic Murmurs with a Mnemonic
Unraveling Diastolic Murmurs
The APTM Mnemonic for Location
Decoding S3 Heart Sounds
How Maneuvers Change Murmurs: Preload and Afterload
Frequently Asked Questions About Heart Murmurs
Keeping It All Straight: Your Next Steps

The Challenge of Cardiac Murmurs

Learning about heart murmurs, particularly distinguishing between systole and diastole, can be a bit of a head-scratcher. It is a common point of confusion for many students and practitioners alike. The heart's rhythm, with its "lub-dub" sounds, actually represents a very complex series of events, and murmurs are just extra sounds that can tell us so much about what's going on inside. Getting them mixed up is, well, pretty normal, actually.

The main problem often comes down to the sheer volume of information. There are so many different murmurs, each with its own timing, location, and unique qualities. Then, you add in the effects of various maneuvers, like standing up or squatting, and it can feel like a lot to process. That's why having a solid system for remembering them is so helpful; it gives your brain a hook to hang the information on.

Understanding Systolic Murmurs with a Mnemonic

When it comes to systolic murmurs, there are four key ones that typically cause the most concern and appear often in discussions. These are often the ones people tend to mix up, so a simple mnemonic can really help. You might hear people refer to them as "Mr, VSD, AS, and HOCM." This little phrase is a very straightforward way to keep these important murmurs in mind, allowing you to recall them quickly when you need to.

Mr: Mitral Regurgitation

Mitral regurgitation, often just called MR, happens when the mitral valve does not close completely during systole. This means blood flows backward from the left ventricle into the left atrium, creating a sound. It is a pansystolic murmur, meaning it lasts throughout the entire systolic phase. Knowing this makes it easier to identify, and it is a good one to keep in mind for that reason, too.

VSD: Ventricular Septal Defect

A ventricular septal defect, or VSD, is a hole in the wall separating the two lower chambers of the heart. When the ventricles contract during systole, blood can shunt from the left ventricle to the right ventricle through this opening. This creates a loud, harsh, pansystolic murmur. It is another murmur that spans the whole systolic period, which helps in its recognition, and it is a significant finding.

AS: Aortic Stenosis

Aortic stenosis, or AS, involves a narrowing of the aortic valve. This makes it harder for blood to leave the left ventricle and go into the aorta during systole. The murmur produced is a crescendo-decrescendo, or diamond-shaped, systolic ejection murmur. It gets louder as blood rushes through the narrowed valve and then softer as the flow decreases. This specific shape is quite distinctive, so it is usually a bit easier to pick out.

HOCM: Hypertrophic Obstructive Cardiomyopathy

Hypertrophic obstructive cardiomyopathy, or HOCM, involves a thickening of the heart muscle, which can obstruct blood flow out of the left ventricle. This also causes a systolic ejection murmur, which can sound quite similar to aortic stenosis. However, its behavior with different maneuvers is key to telling it apart, which we will discuss a little later. It is a condition that, you know, really impacts how the heart functions.

Unraveling Diastolic Murmurs

While the "Mr, VSD, AS, HOCM" mnemonic focuses on systolic murmurs, it is just as important to understand diastolic murmurs. These sounds happen after S2, during the heart's resting and filling phase. Common diastolic murmurs include aortic regurgitation (AR) and mitral stenosis (MS). They are generally a bit harder to hear and identify, but their presence is just as meaningful. For instance, an early diastolic murmur might suggest aortic regurgitation, while a mid-diastolic murmur could point to mitral stenosis, so, you know, the timing is everything.

The APTM Mnemonic for Location

Knowing where to listen for murmurs is absolutely crucial, and that is where the "APTM" mnemonic comes in handy. This simple memory aid helps you remember the four main auscultation areas on the chest, where you can best hear the sounds of each heart valve. It stands for Aortic, Pulmonic, Tricuspid, and Mitral. Memorize the heck out of this one for remembering where to place your stethoscope, as a matter of fact.

The Aortic area is typically found at the second intercostal space, right sternal border. The Pulmonic area is at the second intercostal space, left sternal border. The Tricuspid area sits at the fourth or fifth intercostal space, left sternal border. Finally, the Mitral area, also known as the apex, is usually at the fifth intercostal space, midclavicular line. Knowing these spots helps you pinpoint the origin of any unusual sounds, which is, you know, pretty vital.

Decoding S3 Heart Sounds

Beyond murmurs, other extra heart sounds can provide important clues. One such sound is S3. My text mentions that S3 occurs after S2 and indicates volume overload of the left ventricle. It is the sound of incoming preload hitting a ventricle that is already quite full, or volume overloaded. As such, it is a significant indication of a heart that is struggling to manage its fluid volume. Recognizing S3 is, therefore, a very important part of a cardiac assessment, and it suggests a need for further investigation, obviously.

S3 is often described as a "Kentucky" gallop, reflecting its three-beat rhythm. It typically suggests a dilated ventricle and can be a sign of heart failure. It is a low-pitched sound, so you often need to listen with the bell of your stethoscope, and it is usually best heard at the apex. Being able to distinguish S3 from other sounds, like S4 or a split S2, is a skill that takes practice, but it is certainly worth the effort.

How Maneuvers Change Murmurs: Preload and Afterload

One of the trickiest parts of understanding heart murmurs is how they change with different maneuvers. This is where the concepts of preload and afterload become very important. These terms describe the forces acting on the heart, and knowing how they affect various murmurs can help you differentiate between similar-sounding conditions. My text points out that students often have a difficult time trying to understand preload and afterload effects on heart murmurs, especially when preload increases or decreases. It is a common source of confusion, actually.

What is Preload?

Preload refers to the amount of blood filling the ventricles at the end of diastole, just before the heart contracts. Think of it as the "stretch" on the heart muscle fibers before they squeeze. The more blood returning to the heart, the higher the preload. For example, lying down or squatting can increase preload because more blood returns to the heart. This increased volume can make certain murmurs louder or softer, depending on the specific condition, so it is a key factor.

What is Afterload?

Afterload is the resistance the heart must overcome to pump blood out into the body. It is the pressure the ventricles have to work against to eject blood. High blood pressure, for instance, means the heart has to push harder, increasing afterload. Standing up or performing a Valsalva maneuver can affect afterload. Understanding how these two forces interact with the heart's pumping action is really helpful for interpreting murmur changes.

The Effects of Preload and Afterload on Murmurs

My text asks: "When preload increases/decreases, which murmurs are increased/decreased?" This is a critical question. Generally, murmurs that are due to flow across a narrowed valve (like aortic stenosis) or a shunting of blood (like VSD) tend to get louder with increased preload because there's more blood flowing. Murmurs that are due to an obstruction that gets worse with a fuller ventricle (like HOCM) might behave differently, often getting softer with increased preload. Conversely, maneuvers that decrease preload, like standing quickly, can make HOCM louder, while most other murmurs might get softer. It is a bit counterintuitive sometimes, but it makes sense once you grasp the underlying physiology.

Increasing afterload, say by clenching your fists, often makes murmurs of regurgitation (like MR or AR) louder because the heart has to push harder against resistance, forcing more blood backward through the leaky valve. It can also make a VSD murmur louder. On the other hand, decreasing afterload might soften these murmurs. Knowing these responses is a powerful diagnostic tool, helping you narrow down the possibilities, and it is pretty much essential for accurate assessment.

Frequently Asked Questions About Heart Murmurs

What exactly goes into a review of systems when asking about heart murmurs?

When you are doing a review of systems and thinking about heart murmurs, you want to ask about symptoms that might suggest heart trouble or conditions that cause murmurs. This could include asking if someone has experienced chest pain, shortness of breath, especially with activity or when lying flat, swelling in their legs or feet, or if they have ever fainted. You might also ask about a history of rheumatic fever, a prior heart attack, or any known heart conditions. It is about getting a full picture, you know, of their overall health and any clues that point to the heart.

Is there a good mnemonic to memorize the heart pathway?

Yes, absolutely! While not directly about murmurs, understanding the heart's pathway helps with murmurs. A popular mnemonic for the pathway of blood through the heart is "TRy PuLLing My ARM." This helps you remember the order of the valves and chambers: Tricuspid, Pulmonic, Lungs, Mitral, Aortic, Rest of Body. Knowing this pathway can help you visualize where the blood is flowing and why a murmur might occur at a certain point. Learn more about cardiac circulation on our site.

Can you give a simple explanation for diastole and systole?

Think of systole as the "squeeze" and diastole as the "fill." Systole is when the heart muscle contracts and pushes blood out to the body and lungs. It is the working phase, the "lub" sound. Diastole is when the heart muscle relaxes and fills with blood, preparing for the next squeeze. It is the resting phase, the "dub" sound. Murmurs happen during either of these times, depending on which part of the heart is having trouble. This simple way of thinking about it helps clear up confusion, and it is quite fundamental.

Keeping It All Straight: Your Next Steps

Keeping all the details about heart murmurs straight can feel like a big job, especially when you are trying to remember the nuances of preload and afterload. But with mnemonics like "Mr, VSD, AS, HOCM" for systolic murmurs and "APTM" for locations, you have some powerful tools at your disposal. These little memory tricks, you know, really do make a difference in helping the information stick.

The key, as my text implies, is consistent review. Even with great mnemonics, if you do not revisit the material for a few weeks, things can get jumbled. Try to incorporate a quick review into your routine, perhaps by listening to simulated heart sounds or discussing cases with classmates. You can find many resources online to help with this, including detailed information on heart sounds and murmurs from reliable medical sources. Practice truly makes perfect in this area, so keep at it! We have more resources available to help you understand cardiac physiology too.

Human Heart Wallpapers - Wallpaper Cave

heart anatomy. Part of the human heart Stock Vector Image & Art - Alamy

Heart | Structure, Function, Diagram, Anatomy, & Facts | Britannica

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