Understanding Heart Murmurs – How to Master Auscultation for Step 1 & Step 2

Whether you’re learning them for the first time or reviewing before test day, heart murmurs are a must-know USMLE topic. From aortic stenosis to mitral regurgitation, questions will test not only your knowledge of the murmurs—but your ability to reason through timing, location, and maneuvers.

Systolic vs Diastolic: What You Must Know

Murmur	Timing	Common Cause	Key Clue
Aortic Stenosis	Systolic	Aging, bicuspid aortic valve	Crescendo-decrescendo at R 2nd ICS
Mitral Regurgitation	Systolic	MVP, ischemia, rheumatic	Holosystolic at apex, radiates to axilla
Aortic Regurgitation	Diastolic	Aortic root dilation	Blowing decrescendo at LSB
Mitral Stenosis	Diastolic	Rheumatic fever	Opening snap + rumble at apex (LLDP)

USMLE Tips: Maneuvers and Changes

• Valsalva → decreases preload → murmurs like HOCM and MVP increase

• Squatting → increases preload and afterload → decreases HOCM, increases MR

• Inspiration → increases right-sided murmurs (e.g., tricuspid regurg)

• Expiration → increases left-sided murmurs (e.g., mitral stenosis)

Step 1 & Step 2 Style Clues

A 70-year-old man presents with chest pain and syncope during exertion. Exam reveals a systolic murmur at the right upper sternal border. What’s the most likely diagnosis?
✅ Aortic Stenosis

Which maneuver increases this murmur’s intensity?
✅ Squatting

Mnemonics That Help

“MR. PASS wins the MVP”

• MR, Pulmonic And Static Stenosis = Systolic

• Mitral Valve Prolapse = also systolic

Everything else = diastolic

Common Distractors to Avoid

Murmur Confusion	Key Differentiator
HOCM vs Aortic Stenosis	HOCM increases with Valsalva
Tricuspid Regurg vs Mitral Regurg	TR increases with inspiration
Mitral Stenosis vs Aortic Regurgitation	MS has opening snap; AR has bounding pulse

Why KOTC Makes Cardio Easy

When you're trying to remember location, pitch, timing, and response to maneuvers, a well-placed visual or audio cue is game-changing. The King of the Curve app provides:

• High-yield cardio visuals

• Murmur quizzes with sound-based recall

• Step 1–style clinical vignettes in timed mode

Explore more at 👉 kingofthecurve.org/studyscience

Call to Action

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Frequently Asked Questions (FAQs)

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