Any trick to learn all types of systolic and diastolic murmer

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I now have everything I need to give a thorough, mnemonic-rich answer. Let me compile this into a complete, organized response.

Here is a complete trick-based guide to remembering all types of systolic and diastolic murmurs, built around mnemonics and the classic Harrison's/Braunwald framework.

Heart Murmurs: The Complete Memory System

The Master Diagram (from Harrison's, Fig. 44-1)

First, burn this image into memory - it shows every murmur pattern relative to S1 and S2:

Principal heart murmurs diagram - Harrison's Fig. 44-1

A = Presystolic (just before S1) - Mitral/Tricuspid Stenosis in sinus rhythm
B = Holosystolic (plateau, S1 to S2) - MR, TR, VSD
C = Ejection systolic (crescendo-decrescendo, starts after S1, ends before S2) - AS, with ejection click
D = Late systolic spilling past A2 - Pulmonary Stenosis (delayed P2)
E = Early diastolic decrescendo - AR or PR (starts at S2)
F = Mid-to-late diastolic after Opening Snap - Mitral Stenosis
G = Short mid-diastolic after S3 - rapid filling murmur
H = Continuous (throughout S1 and S2) - PDA (machinery murmur)

SYSTOLIC MURMURS

The Core Trick: "HELP MV"

HOCM, Ejection (AS/PS), Late systolic (MVP), Pansystolic/Holo (MR, TR, VSD), Mitral valve prolapse click, VSD

More practically, split into 2 groups:

Group 1 - Ejection (Crescendo-Decrescendo) Murmurs

Mnemonic: "ARPO" - Aortic Right Pulmonary Outflow

Condition	Location	Radiation	Trick to Remember
Aortic Stenosis (AS)	Right 2nd ICS (aortic area)	Carotids	"AS radiates to the neck (it's going up)"
Pulmonary Stenosis (PS)	Left 2nd ICS	Left shoulder	"PS stays on the left"
HOCM	Lower left sternal border	Does NOT radiate to carotids	"HOCM is stubborn - doesn't go up"
ASD	Left 2nd-3rd ICS	-	High flow across pulmonary valve - "ASD = A lot of flow across pulmonary area"

Shape trick: These are all diamond-shaped (crescendo then decrescendo). Think of a mountain peak.

Group 2 - Pansystolic / Holosystolic (Plateau) Murmurs

Mnemonic: "MR T. VSD" (sounds like "Mr. VSD")

Condition	Location	Radiation	Trick
Mitral Regurgitation (MR)	Apex	Axilla	"MR goes to the arMpit (axilla)"
Tricuspid Regurgitation (TR)	Lower left sternal border	Right sternal border	"TR = Tricuspid = lower Tip of sternum; increases with inspiration (Carvallo's sign)"
VSD	Left sternal border 3rd-4th ICS	Entire precordium	"VSD is loud (grade 4-5) - small hole = big noise"

Shape trick: These are flat/plateau throughout systole - same pressure gradient from start to finish.

Group 3 - Late Systolic

Only one to remember: Mitral Valve Prolapse (MVP)

Midsystolic click followed by late systolic murmur
Apex, heard best in left lateral decubitus
Trick: "MVP = click then crescendo to S2 (like a car that revs up late)"
Maneuvers: Standing/Valsalva makes it earlier and louder (less preload = earlier click)

DIASTOLIC MURMURS

Golden rule (always remember this): Any diastolic murmur is always pathological and warrants echocardiography. - Symptom to Diagnosis, 4th Ed.

The Core Trick: "APPY" for diastolic murmurs

Aortic regurgitation (early), Pulmonary regurgitation (early), Presystolic (MS in sinus rhythm), Yell "Rumble" for MS mid-diastolic

Split into 2 groups:

Group 1 - Early Diastolic (Decrescendo) - "Regurgitation murmurs"

Mnemonic: "DAB" - Decrescendo At the Base

Condition	Location	Best heard	Trick
Aortic Regurgitation (AR)	Left sternal border 3rd ICS	Leaning forward, breath held in expiration	"AR = forward lean to hear; blowing, high-pitched"
Pulmonary Regurgitation (PR) / Graham Steell murmur	Left 2nd ICS	Increases with inspiration	"Graham Steell = pulmonary HTN - think Eisenmenger"

Shape trick: These are decrescendo - the pressure gradient narrows as diastole progresses.

Group 2 - Mid-to-Late Diastolic (Rumble) - "Stenosis murmurs"

Mnemonic: "MATT Rumbles" - Mitral And Tricuspid Tricuspid/Tumors Rumble

Condition	Location	Special feature	Trick
Mitral Stenosis (MS)	Apex (bell)	Opening Snap then rumble; presystolic accentuation in sinus rhythm	"MS = OS then low rumble at apex"
Tricuspid Stenosis (TS)	Lower left sternal border	Increases with inspiration	"TS = like MS but on the right side"
Austin Flint murmur	Apex	Mid-late diastolic rumble in severe AR	"Flint = functional MS caused by AR jet hitting mitral leaflet"
Carey Coombs murmur	Apex	Mid-diastolic in acute rheumatic fever	"Coombs = rheumatic fever (Coombs sounds like rheumatic)"

CONTINUOUS MURMUR

Mnemonic: "PDA MARCHes"

PDA, Mammary souffle, Arteriovenous fistula, Rupture of Sinus of Valsalva, Coronary AV fistula, Hum (venous hum in children)

The classic is PDA (Patent Ductus Arteriosus) - "machinery murmur," heard best at left infraclavicular region, peaks at S2, goes into diastole.

MASTER SUMMARY TABLE

Timing	Type	Condition	Mnemonic
Systolic	Ejection (C-D)	AS, PS, HOCM, ASD	"ARPO"
Systolic	Pansystolic	MR, TR, VSD	"Mr. VSD"
Systolic	Late systolic	MVP	"Click then Rev"
Diastolic	Early (decrescendo)	AR, PR	"DAB"
Diastolic	Mid-late (rumble)	MS, TS, Austin Flint, Carey Coombs	"MATT Rumbles"
Continuous	Throughout cycle	PDA, AV fistula	"PDA MARCHes"

Bedside Maneuver Tricks (SUPER helpful for exams)

"SURE" to remember maneuver effects:

Standing / Valsalva = decrease preload = louder HOCM, MVP click moves earlier; softer AS, MR, VSD
Upright to squatting = increase preload = opposite of above
Respiration - Inspiration increases right-sided murmurs (Carvallo's sign for TR/TS/PS)
Exercise / hand grip = increases afterload = louder MR, VSD, AR; softer HOCM

The Evaluation Flowchart (Harrison's Fig. 243-1)

Key takeaway from the flowchart: A grade I-II midsystolic murmur in an asymptomatic young person with no other findings = likely benign, no echo needed. Any diastolic or continuous murmur = always get an echo.

Sources: Harrison's Principles of Internal Medicine 22E (2025), Ch. 44; Symptom to Diagnosis, 4th Ed.

Make a quick-reference PDF card with murmur mnemonics

Reading File

Running Command

ls /home/daytona/workspace/ 2>/dev/null && echo "---" && python3 -c "import repo…

Running Command

mkdir -p /home/daytona/workspace/murmur-card

Writing File

~/murmur-card/make_card.py

from reportlab.pdfgen import canvas
from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.platypus import Table, TableStyle
from reportlab.lib.colors import HexColor

OUTPUT = "/home/daytona/workspace/murmur-card/Murmur_Quick_Reference.pdf"

# ── colour palette ──────────────────────────────────────────────
C_BG        = HexColor("#0D1B2A")   # deep navy background
C_HEADER    = HexColor("#1E3A5F")   # section header bar
C_ACCENT1   = HexColor("#E63946")   # systolic red
C_ACCENT2   = HexColor("#457B9D")   # diastolic blue
C_ACCENT3   = HexColor("#2A9D8F")   # continuous teal
C_ACCENT4   = HexColor("#E9C46A")   # gold for mnemonics
C_WHITE     = colors.white
C_LIGHT     = HexColor("#A8DADC")
C_DARK_ROW  = HexColor("#132337")
C_MID_ROW   = HexColor("#1A2E45")

W, H = A4   # 595.27 x 841.89 pt
MARGIN = 14 * mm

def hex_col(h):
    return HexColor(h)

def make_card():
    c = canvas.Canvas(OUTPUT, pagesize=A4)
    c.setTitle("Heart Murmurs Quick Reference")

    # ── BACKGROUND ───────────────────────────────────────────────
    c.setFillColor(C_BG)
    c.rect(0, 0, W, H, fill=1, stroke=0)

    # ── TOP TITLE BAR ────────────────────────────────────────────
    bar_h = 28 * mm
    c.setFillColor(C_HEADER)
    c.rect(0, H - bar_h, W, bar_h, fill=1, stroke=0)

    # Red accent strip at very top
    c.setFillColor(C_ACCENT1)
    c.rect(0, H - 3.5 * mm, W, 3.5 * mm, fill=1, stroke=0)

    c.setFillColor(C_WHITE)
    c.setFont("Helvetica-Bold", 20)
    c.drawCentredString(W / 2, H - 14 * mm, "HEART MURMURS  —  QUICK REFERENCE CARD")
    c.setFont("Helvetica", 9)
    c.setFillColor(C_LIGHT)
    c.drawCentredString(W / 2, H - 21 * mm, "Mnemonics  •  Classification  •  Bedside Maneuvers  |  Harrison's 22E / Braunwald")

    y = H - bar_h - 6 * mm   # starting Y cursor

    # ─────────────────────────────────────────────────────────────
    # Helper functions
    # ─────────────────────────────────────────────────────────────
    def section_header(title, color, y_pos, icon=""):
        c.setFillColor(color)
        c.roundRect(MARGIN, y_pos - 7 * mm, W - 2 * MARGIN, 8.5 * mm, 3, fill=1, stroke=0)
        c.setFillColor(C_WHITE)
        c.setFont("Helvetica-Bold", 11)
        c.drawString(MARGIN + 4 * mm, y_pos - 4.5 * mm, icon + "  " + title if icon else title)
        return y_pos - 9 * mm

    def mnemonic_box(mnemonic, explanation, y_pos, color=C_ACCENT4):
        box_h = 11 * mm
        c.setFillColor(HexColor("#1A2D42"))
        c.setStrokeColor(color)
        c.setLineWidth(1.2)
        c.roundRect(MARGIN, y_pos - box_h, W - 2 * MARGIN, box_h, 4, fill=1, stroke=1)
        c.setFillColor(color)
        c.setFont("Helvetica-Bold", 10.5)
        label = f"  Mnemonic: \"{mnemonic}\""
        c.drawString(MARGIN + 3 * mm, y_pos - 5 * mm, label)
        c.setFillColor(C_WHITE)
        c.setFont("Helvetica", 8.5)
        c.drawString(MARGIN + 3 * mm, y_pos - 9 * mm, explanation)
        return y_pos - box_h - 2 * mm

    def draw_table(data, col_widths, y_pos, row_colors=None):
        """Draw a simple table; returns new y position."""
        row_h = 7.2 * mm
        tbl_w = sum(col_widths)
        x0 = MARGIN

        default_row_colors = [C_DARK_ROW, C_MID_ROW]

        for ri, row in enumerate(data):
            is_header = (ri == 0)
            bg = C_HEADER if is_header else default_row_colors[ri % 2]
            if row_colors and ri < len(row_colors) and row_colors[ri]:
                bg = row_colors[ri]

            c.setFillColor(bg)
            c.rect(x0, y_pos - row_h, tbl_w, row_h, fill=1, stroke=0)

            # subtle separator line
            c.setStrokeColor(HexColor("#253D57"))
            c.setLineWidth(0.4)
            c.line(x0, y_pos - row_h, x0 + tbl_w, y_pos - row_h)

            xi = x0
            for ci, cell in enumerate(row):
                cw = col_widths[ci]
                if is_header:
                    c.setFillColor(C_LIGHT)
                    c.setFont("Helvetica-Bold", 8)
                else:
                    # First col bold white, rest normal
                    if ci == 0:
                        c.setFillColor(C_WHITE)
                        c.setFont("Helvetica-Bold", 8)
                    elif ci == 1:
                        c.setFillColor(C_ACCENT4)
                        c.setFont("Helvetica-Bold", 8)
                    else:
                        c.setFillColor(HexColor("#C8DCE8"))
                        c.setFont("Helvetica", 7.5)
                c.drawString(xi + 2.5 * mm, y_pos - 5.5 * mm, str(cell))
                xi += cw

            y_pos -= row_h

        return y_pos - 2 * mm

    def bullet(text, y_pos, indent=0, color=C_WHITE, size=8, bold=False):
        c.setFillColor(C_ACCENT4)
        c.circle(MARGIN + indent + 2.5 * mm, y_pos - 2.5 * mm, 1.2, fill=1, stroke=0)
        c.setFillColor(color)
        fnt = "Helvetica-Bold" if bold else "Helvetica"
        c.setFont(fnt, size)
        c.drawString(MARGIN + indent + 5.5 * mm, y_pos - 4 * mm, text)
        return y_pos - 5.5 * mm

    # ─────────────────────────────────────────────────────────────
    # SECTION 1 – SYSTOLIC MURMURS
    # ─────────────────────────────────────────────────────────────
    y = section_header("SYSTOLIC MURMURS", C_ACCENT1, y, icon="▶")
    y -= 1 * mm

    y = mnemonic_box("HELP MV",
        "Hypertrophic (HOCM)  •  Ejection (AS/PS)  •  Late systolic (MVP)  •  Pansystolic (MR/TR/VSD)  •  Murmur (innocent)  •  VSD",
        y, C_ACCENT1)
    y -= 1.5 * mm

    # Sub-header: Ejection
    c.setFillColor(HexColor("#C1121F"))
    c.setFont("Helvetica-Bold", 8.5)
    c.drawString(MARGIN + 2 * mm, y - 1 * mm, "GROUP 1 — Ejection (Crescendo-Decrescendo)  [ diamond-shaped ]   Mnemonic: \"ARPO\"")
    y -= 6 * mm

    col_w1 = [42*mm, 34*mm, 38*mm, 60*mm]
    sys_ejection = [
        ["Condition", "Mnemonic", "Location", "Key Trick"],
        ["Aortic Stenosis (AS)", "ARPO - A", "R 2nd ICS → Carotids", "Radiates to neck  •  Gallavardin effect at apex"],
        ["Pulmonary Stenosis (PS)", "ARPO - P", "L 2nd ICS → L shoulder", "Delayed P2  •  Louder on inspiration"],
        ["HOCM", "ARPO - O", "L lower sternal border", "No carotid radiation  •  ↑ Valsalva/Standing"],
        ["ASD", "ARPO - A", "L 2nd-3rd ICS", "High flow across pulmonary  •  Fixed split S2"],
    ]
    y = draw_table(sys_ejection, col_w1, y)

    c.setFillColor(HexColor("#C1121F"))
    c.setFont("Helvetica-Bold", 8.5)
    c.drawString(MARGIN + 2 * mm, y - 1 * mm, "GROUP 2 — Pansystolic / Holosystolic  [ plateau ]   Mnemonic: \"MR. VSD\"")
    y -= 6 * mm

    col_w2 = [42*mm, 34*mm, 38*mm, 60*mm]
    sys_pan = [
        ["Condition", "Mnemonic", "Location", "Key Trick"],
        ["Mitral Regurgitation (MR)", "MR. VSD - M", "Apex → Axilla", "Radiates to arMpit  •  ↑ handgrip/squatting"],
        ["Tricuspid Regurgitation (TR)", "MR. VSD - R", "L lower sternal → RSB", "Carvallo's sign: ↑ inspiration  •  JVP raised"],
        ["VSD", "MR. VSD - V", "L sternal 3rd-4th ICS", "Grade 4-5  •  Small hole = BIG noise"],
    ]
    y = draw_table(sys_pan, col_w2, y)

    c.setFillColor(HexColor("#C1121F"))
    c.setFont("Helvetica-Bold", 8.5)
    c.drawString(MARGIN + 2 * mm, y - 1 * mm, "GROUP 3 — Late Systolic")
    y -= 6 * mm
    y = bullet("MVP (Mitral Valve Prolapse): Midsystolic CLICK → late crescendo murmur to S2  •  \"Click then Rev\"", y, color=C_WHITE)
    y = bullet("Standing / Valsalva → click moves EARLIER  •  Squatting → click moves LATER", y, color=HexColor("#C8DCE8"))
    y -= 3 * mm

    # ─────────────────────────────────────────────────────────────
    # SECTION 2 – DIASTOLIC MURMURS
    # ─────────────────────────────────────────────────────────────
    y = section_header("DIASTOLIC MURMURS  —  Always Pathological → Always Echo", C_ACCENT2, y, icon="◀")
    y -= 1 * mm

    # Gold rule banner
    c.setFillColor(HexColor("#1A2D42"))
    c.setStrokeColor(C_ACCENT4)
    c.setLineWidth(1)
    c.roundRect(MARGIN, y - 8*mm, W - 2*MARGIN, 8*mm, 3, fill=1, stroke=1)
    c.setFillColor(C_ACCENT4)
    c.setFont("Helvetica-Bold", 9)
    c.drawCentredString(W/2, y - 5.5*mm,
        "⚠  Any diastolic murmur = ALWAYS abnormal  •  Warrants echocardiography  •  Never benign")
    y -= 10 * mm

    y = mnemonic_box("APPY",
        "Aortic regurgitation (early)  •  Pulmonary regurgitation (early)  •  Presystolic MS  •  \"Y\"ell Rumble = MS mid-diastolic",
        y, C_ACCENT2)
    y -= 1.5 * mm

    c.setFillColor(HexColor("#1A6B8A"))
    c.setFont("Helvetica-Bold", 8.5)
    c.drawString(MARGIN + 2*mm, y - 1*mm, "GROUP 1 — Early Diastolic Decrescendo   Mnemonic: \"DAB\" (Decrescendo At Base)")
    y -= 6*mm

    col_w3 = [48*mm, 28*mm, 42*mm, 56*mm]
    dias_early = [
        ["Condition", "Mnemonic", "Location", "Key Trick"],
        ["Aortic Regurgitation (AR)", "DAB - A", "L sternal border 3rd ICS", "Lean forward + breath held  •  Blowing high-pitch"],
        ["Pulmonary Regurgitation (PR)", "DAB - D", "L 2nd ICS", "Graham Steell = pulmonary HTN/Eisenmenger"],
    ]
    y = draw_table(dias_early, col_w3, y)

    c.setFillColor(HexColor("#1A6B8A"))
    c.setFont("Helvetica-Bold", 8.5)
    c.drawString(MARGIN + 2*mm, y - 1*mm, "GROUP 2 — Mid-to-Late Diastolic Rumble   Mnemonic: \"MATT Rumbles\"")
    y -= 6*mm

    col_w4 = [48*mm, 28*mm, 42*mm, 56*mm]
    dias_mid = [
        ["Condition", "Mnemonic", "Location", "Key Trick"],
        ["Mitral Stenosis (MS)", "MATT - M", "Apex (bell)", "Opening snap → Low rumble  •  Presystolic accentuation"],
        ["Tricuspid Stenosis (TS)", "MATT - T", "L lower sternal border", "Like MS but RIGHT-sided  •  ↑ inspiration"],
        ["Austin Flint murmur", "MATT - A", "Apex", "Functional MS from AR jet hitting mitral leaflet"],
        ["Carey Coombs murmur", "MATT - C", "Apex", "Rheumatic fever  •  Mid-diastolic  •  Acute"],
    ]
    y = draw_table(dias_mid, col_w4, y)
    y -= 2*mm

    # ─────────────────────────────────────────────────────────────
    # SECTION 3 – CONTINUOUS + BEDSIDE MANEUVERS  (two columns)
    # ─────────────────────────────────────────────────────────────
    left_x  = MARGIN
    right_x = W / 2 + 3*mm
    col_half = W / 2 - MARGIN - 3*mm

    save_y = y

    # LEFT: Continuous murmur
    c.setFillColor(C_ACCENT3)
    c.roundRect(left_x, y - 7*mm, col_half, 8.5*mm, 3, fill=1, stroke=0)
    c.setFillColor(C_WHITE)
    c.setFont("Helvetica-Bold", 10)
    c.drawString(left_x + 3*mm, y - 4.5*mm, "⟳  CONTINUOUS MURMUR")
    y -= 9*mm

    y = mnemonic_box("PDA MARCHes",
        "PDA • Mammary souffle • AV fistula • Ruptured Sinus of Valsalva • Coronary AV fistula • Hum (venous)",
        y, C_ACCENT3)

    y = bullet("PDA = 'Machinery murmur'  •  L infraclavicular  •  Peaks at S2", y, color=C_WHITE)
    y = bullet("Venous hum = benign in children  •  disappears on lying down", y, color=HexColor("#C8DCE8"))

    # RIGHT COLUMN: Bedside Maneuvers
    y2 = save_y
    c.setFillColor(C_ACCENT4)
    c.roundRect(right_x, y2 - 7*mm, col_half, 8.5*mm, 3, fill=1, stroke=0)
    c.setFillColor(C_BG)
    c.setFont("Helvetica-Bold", 10)
    c.drawString(right_x + 3*mm, y2 - 4.5*mm, "✋  BEDSIDE MANEUVERS  —  \"SURE\"")
    y2 -= 9*mm

    maneuver_data = [
        ["Maneuver", "↑ preload?", "Effect"],
        ["Valsalva / Stand", "↓ Preload", "HOCM ↑  •  MVP earlier  •  AS/MR ↓"],
        ["Squat / Lie down", "↑ Preload", "HOCM ↓  •  MVP later  •  AS/MR ↑"],
        ["Inspiration", "↑ R-sided", "TR/TS/PS ↑ (Carvallo's sign)"],
        ["Handgrip", "↑ Afterload", "MR/VSD/AR ↑  •  HOCM/AS ↓"],
    ]
    col_wm = [36*mm, 26*mm, col_half - 62*mm]

    row_h = 7.2*mm
    tbl_w2 = sum(col_wm)
    xi0 = right_x
    for ri, row in enumerate(maneuver_data):
        is_hdr = (ri == 0)
        bg = C_HEADER if is_hdr else [C_DARK_ROW, C_MID_ROW][ri % 2]
        c.setFillColor(bg)
        c.rect(xi0, y2 - row_h, tbl_w2, row_h, fill=1, stroke=0)
        c.setStrokeColor(HexColor("#253D57"))
        c.setLineWidth(0.4)
        c.line(xi0, y2 - row_h, xi0 + tbl_w2, y2 - row_h)
        xi = xi0
        for ci, cell in enumerate(row):
            cw = col_wm[ci]
            if is_hdr:
                c.setFillColor(C_LIGHT); c.setFont("Helvetica-Bold", 8)
            elif ci == 0:
                c.setFillColor(C_ACCENT4); c.setFont("Helvetica-Bold", 8)
            elif ci == 1:
                c.setFillColor(HexColor("#A8DADC")); c.setFont("Helvetica", 7.5)
            else:
                c.setFillColor(C_WHITE); c.setFont("Helvetica", 7.5)
            c.drawString(xi + 2.5*mm, y2 - 5.5*mm, str(cell))
            xi += cw
        y2 -= row_h

    # ─────────────────────────────────────────────────────────────
    # FOOTER
    # ─────────────────────────────────────────────────────────────
    footer_y = 9*mm
    c.setFillColor(C_HEADER)
    c.rect(0, 0, W, footer_y + 2*mm, fill=1, stroke=0)
    c.setFillColor(HexColor("#6B8EAD"))
    c.setFont("Helvetica", 7)
    c.drawString(MARGIN, footer_y - 2*mm,
        "Sources: Harrison's Principles of Internal Medicine 22E (2025)  •  Braunwald's Heart Disease  •  Symptom to Diagnosis 4E")
    c.setFont("Helvetica-Bold", 7)
    c.setFillColor(C_LIGHT)
    c.drawRightString(W - MARGIN, footer_y - 2*mm, "Orris Medical  •  Quick Reference Card")

    c.setFillColor(C_ACCENT1)
    c.rect(0, footer_y + 2*mm, W, 1.5, fill=1, stroke=0)

    c.save()
    print(f"PDF saved: {OUTPUT}")

make_card()

Running Command

cd /home/daytona/workspace/murmur-card && python3 make_card.py

Running Command

ls -lh /home/daytona/workspace/murmur-card/Murmur_Quick_Reference.pdf

Your quick-reference PDF card is ready. Here's what's packed into the single A4 page:

Murmur Quick Reference
PDF Document · PDF

What's on the card:

Systolic Murmurs (red section)

Master mnemonic "HELP MV"
Group 1 - Ejection murmurs table with "ARPO" mnemonic (AS, PS, HOCM, ASD)
Group 2 - Pansystolic murmurs table with "MR. VSD" mnemonic
Group 3 - Late systolic (MVP) with the "Click then Rev" trick

Diastolic Murmurs (blue section)

Gold banner rule: "Any diastolic murmur = ALWAYS abnormal → Echo"
"APPY" master mnemonic
Group 1 - Early decrescendo table with "DAB" mnemonic (AR, PR)
Group 2 - Mid-late rumble table with "MATT Rumbles" (MS, TS, Austin Flint, Carey Coombs)

Continuous Murmurs (teal section)

"PDA MARCHes" mnemonic

Bedside Maneuvers (gold section)

"SURE" mnemonic - Valsalva/Stand, Squat/Lie, Inspiration, Handgrip with effect on each murmur

Footer cites Harrison's 22E, Braunwald's, and Symptom to Diagnosis 4E.

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