Hey please give a short tricks to remember murmurs and where they are

Hey please give a short tricks to remember murmurs and where they are heard how nbme or step test makers gonna ask acc. To previous papers . Tricks to solve them stratigically and bot wasting time there

Here's a quick-fire memory system for cardiac murmurs - built around how NBME/Step actually tests them.

The Master Cheat Sheet: Cardiac Murmurs

1. LOCATION LANDMARKS (memorize these 4 anchor points)

Area	Location	Mnemonic
Aortic	Right 2nd ICS	"Aorta = Right 2" → AR2
Pulmonic	Left 2nd ICS	"Pulmonic = Left 2" → PL2
Tricuspid	Left 4th/5th ICS (sternal border)	"Tri = 4" (4 letters in "Tri")
Mitral	Left 5th ICS midclavicular line	"Mitral = Apex" → MA (Mitral Apex)

Memory trick: "All Patients Take Medicine" = Aortic, Pulmonic, Tricuspid, Mitral (going counterclockwise on the chest)

2. SYSTOLIC vs DIASTOLIC - THE GOLDEN RULE

"PASS" = Pulmonic/Aortic Stenosis are Systolic "MR T" = Mitral Regurg + Tricuspid Regurg are Systolic

So in systole (heart contracts, blood goes OUT):

Outflow valves (Aortic, Pulmonic) STENOSIS = obstructed ejection → systolic murmur
Inlet valves (Mitral, Tricuspid) REGURGITATION = blood leaks back → systolic murmur

Flip everything for diastole:

AR/PR (aortic/pulmonic regurg) = diastolic
MS/TS (mitral/tricuspid stenosis) = diastolic

3. THE BIG 8 - HIGH YIELD TABLE

Murmur	Timing	Location	Radiation	Quality	Key Trick
Aortic Stenosis (AS)	Systolic (crescendo-decrescendo)	Right 2nd ICS	To carotids	Harsh	"Old man, carotids, syncope/angina/HF"
Aortic Regurg (AR)	Early diastolic (decrescendo)	Left sternal border	-	Blowing	Lean forward + hold breath = louder
Mitral Stenosis (MS)	Mid-diastolic	Apex	-	Rumbling + opening snap	Rheumatic fever, afib, loud S1
Mitral Regurg (MR)	Holosystolic	Apex	To axilla	Blowing	"Axilla" = MR. Radiation = axilla
MVP	Late systolic (after click)	Apex	-	-	Click then murmur. Valsalva = earlier click
Tricuspid Regurg (TR)	Holosystolic	Left 4th ICS	-	Blowing	Increases with inspiration (Carvallo's sign)
Pulmonic Stenosis (PS)	Systolic (crescendo-decrescendo)	Left 2nd ICS	-	Harsh	Loud P2 is absent
HCM	Systolic (mid)	Left sternal border	-	Harsh	Valsalva/standing LOUDER, squatting SOFTER

4. THE TWO MANEUVERS NBME LOVES - MASTER THESE

NBME absolutely hammers maneuvers. Learn this table cold:

Maneuver	Preload	What happens
Valsalva / Standing	↓ preload	Most murmurs ↓ EXCEPT HCM and MVP (both get louder)
Squatting / Leg raise	↑ preload	Most murmurs ↑ EXCEPT HCM and MVP (both get softer)
Inspiration	↑ right heart filling	Right-sided murmurs louder (TR, PS, TS) = Carvallo's sign
Expiration	↑ left heart filling	Left-sided murmurs louder (AS, MR, MS, AR)
Handgrip	↑ afterload	AR, MR, VSD louder. AS softer

Memory trick for HCM/MVP:

"HCM and MVP are divas - they get LOUDER when the heart is EMPTIER (less preload = more obstruction/prolapse)"

5. HOW NBME ASKS - COMMON QUESTION STEMS

Pattern 1 - "The murmur changes with..." → They describe a maneuver and ask what murmur. Use the table above.

Pattern 2 - "Where is this best heard?" → They describe quality + timing. Map to the Big 8 table.

Pattern 3 - "Young athlete collapses" → Answer = HCM (not AS in young people). Murmur louder with Valsalva.

Pattern 4 - "Elderly with syncope/chest pain on exertion" → Answer = AS. Crescendo-decrescendo at right 2nd ICS, radiates to carotids. Pulsus parvus et tardus.

Pattern 5 - "Rheumatic fever history + atrial fibrillation" → Answer = MS. Opening snap + mid-diastolic rumble at apex.

Pattern 6 - "IV drug user or right heart involvement" → Answer = TR. Increases with inspiration.

Pattern 7 - "Holosystolic murmur radiating to axilla" → Answer = MR. Always.

6. THE 60-SECOND DECISION TREE (exam strategy)

Step 1: TIMING?
   Systolic → AS, PS, MR, TR, HCM, MVP, VSD
   Diastolic → AR, PR, MS, TS

Step 2: LOCATION?
   Right 2nd ICS → AS
   Left 2nd ICS → PS or AR (if diastolic)
   Apex → MR or MS
   Left sternal border → HCM, TR, AR, VSD

Step 3: RADIATION / SPECIAL FEATURE?
   Carotids → AS
   Axilla → MR
   Opening snap → MS
   Click preceding → MVP
   Inspiration increases → right-sided (TR, TS, PS)

Step 4: MANEUVER given?
   Valsalva louder → HCM or MVP (only exceptions!)
   Handgrip louder → MR, AR, VSD

7. BONUS MEMORY HOOKS

"MS = Midlife Stenosis" - always rheumatic, always mitral, always rumble
"AR = Aortic Runs away" - decrescendo, blows right after S2, marfan/syphilis/endocarditis
"MR = Mitral Runs to axilla" - radiation to axilla, holosystolic
"HCM hates squatting" - squatting fills the heart, HCM disappears
"AS = old, slow, sadistic" - pulsus parvus et tardus, syncope, angina, dyspnea (SAD triad)

These 7 components cover ~95% of how Step 1/2 and NBME shelf exams test murmurs. The maneuver table is the single most tested concept - if you nail that, you'll never miss a murmur question again.

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