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Here is a quick mnemonic “EARLY SYSTOLIC MURMUR to remember about Early Systolic Heart Murmur

This can be valuable for patients as well as medical doctors, nurses & students doing their clinical rounds. You can also find it very useful for med exams like USMLE, NExT Medical Step 1&2, MBBS, NEET PG, INI-CET, FMGE,MCAT & NCLEX exams

Early Systolic Heart Murmur : How To Remember Easily ?

  • E – Early systolic murmurs begin with S1 and extend for a variable period.
  • A – Acute, severe MR into a normal-sized, relatively non-compliant left atrium results in an early, decrescendo systolic murmur.
  • R – Reflect the progressive attenuation of the pressure gradient between the left ventricle and the left atrium during systole.
  • L – Left atrial pressure caused by the sudden volume load into an unprepared, noncompliant chamber.
  • Y – You may hear the murmur at or just medial to the apical impulse.
  • S – Sudden volume load into an unprepared, noncompliant chamber.
  • Y – You should distinguish it from the murmur associated with post-MI ventricular septal rupture.
  • S – Signaled by chest pain, hypotension, and pulmonary edema.
  • T – Transthoracic echocardiography (TTE) is indicated for evaluation.
  • O– Oxygen saturations should be sequentially determined to differentiate it from ventricular septal rupture.
  • L – Left ventricular size and systolic function should be assessed.
  • I – In all cases of suspected acute, severe MR, TTE is indicated.
  • C – Congenital, small muscular VSD may be associated with an early systolic murmur.
  • M – Murmur is localized to the left sternal border and usually of grade 4 or 5 intensity.
  • U – Uncorrected VSDs may lead to pulmonary hypertension.
  • R – Right ventricular lift and loud S2 may predominate in the presence of pulmonary hypertension.
  • M – Murmur associated with TR may increase in intensity with inspiration.
  • U – Usually soft (grade 1 or 2) and best heard at the lower left sternal border.
  • R – Regurgitant c-v waves may be visible in the jugular venous pulse.


Dr. Arin Nandi

Passionate About Medical Science & Helping Future Doctors Achieve Top Ranks In Medical Exams. He is professionally a dentist as well as a public health expert from JIPMER (1), (2)working in health department