You are currently viewing Late Systolic Heart Murmur – Mnemonic

Here is a quick mnemonic “LATE SYSTOLIC MURmur to remember about Late 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

Late Systolic Heart Murmur: How To Remember Easily ?

  • L – Left ventricular apex: A late systolic murmur that is best heard at the left ventricular apex is usually due to MVP.
  • A – Anterior leaflet prolapse: Anterior leaflet prolapse or flail results in a posteriorly directed MR jet that radiates to the axilla or left infrascapular region.
  • T – Tethering and malcoaptation: A late, apical systolic murmur indicative of MR may be heard transiently in the setting of acute myocardial ischemia; it is due to apical tethering and malcoaptation of the leaflets.
  • E – Enhanced flow: The presence of an S3 or a short, rumbling mid-diastolic murmur due to enhanced flow signifies severe MR.
  • S – Standing and squatting: Bedside maneuvers that decrease left ventricular preload, such as standing, will cause the click and murmur of MVP to move closer to the first heart sound. With squatting, the murmur moves away from the first heart sound.
  • Y – Young, thin-chested patients: Leaflet flail is associated with a murmur of grade 3 or 4 intensity that can be heard throughout the precordium in thin-chested patients.
  • S – Specific mitral leaflet: The radiation of the murmur can help identify the specific mitral leaflet involved in the process of prolapse or flail.
  • T – TTE: Transthoracic echocardiography (TTE) is recommended for the assessment of late systolic murmurs.
  • O – Overlapping with AS: The murmur of posterior leaflet prolapse or flail can masquerade as aortic stenosis (AS) because the resultant jet of mitral regurgitation is directed anteriorly and medially.
  • L – Loud and long: Standing causes the murmur of MVP to become louder and longer.
  • I – Increase in afterload: The intensity of the late systolic murmur may increase in the setting of hypertension due to increased left ventricular afterload.
  • C – Clicks: Often, the late systolic murmur is introduced by one or more nonejection clicks.
  • M – MVP: A late systolic murmur at the left ventricular apex is usually due to mitral valve prolapse (MVP).
  • U – Unsupported portion: The term “flail” refers to the movement made by an unsupported portion of the leaflet (usually the tip) after loss of its chordal attachment(s).
  • R – Radiates to base or axilla: With posterior leaflet prolapse or flail, the resultant jet of mitral regurgitation radiates to the base of the heart or axilla.


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