From the Guidelines
To recognize and learn heart murmurs effectively, focus on a systematic approach combining auditory practice with understanding of cardiac physiology, as outlined in the 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease 1. This approach should start by using high-quality recordings of heart murmurs available through medical education apps or online resources, listening repeatedly to familiarize yourself with the distinct sounds.
- Practice with a good stethoscope on standardized patients or simulators if available.
- Learn the timing (systolic vs diastolic), location (aortic, pulmonic, tricuspid, or mitral areas), radiation patterns, intensity (grades 1-6), pitch, and quality (harsh, blowing, musical) of each murmur.
- Create mnemonics to remember key characteristics - for example, mitral regurgitation produces a holosystolic "whooshing" sound best heard at the apex, as described in the classification of murmurs section of the guidelines 1. Use visualization techniques to connect the sound with the underlying pathophysiology, such as imagining turbulent blood flow through a stenotic valve. Regular practice with immediate feedback from experienced clinicians is crucial for improvement, as emphasized in the approach to the patient section of the guidelines 1. Understanding the hemodynamics behind each murmur (like how aortic stenosis creates a crescendo-decrescendo systolic murmur) will help you recognize patterns rather than memorizing individual sounds. This approach works because heart murmurs follow predictable acoustic patterns based on their underlying cardiac abnormalities, and echocardiography is recommended for asymptomatic patients with certain types of murmurs, as well as for patients with symptoms or signs of heart disease 1.
From the Research
Recognizing and Learning Heart Murmurs
To recognize and learn heart murmurs, several methods can be employed, including:
- Online modules with auditory clips and written descriptions, as seen in the Murmur Online Learning Experience (MOLE) curriculum 2
- Visualization of heart sounds and murmurs using smartphone apps, such as the one developed in the study published in Cardiology 3
- A systematic approach to bedside differentiation of cardiac murmurs and abnormal sounds, involving observation of changes in murmur characteristics during various maneuvers 4
- Systematic auscultation on the five standard auscultation points, with exact documentation of every sound and notation of splitting of heart sounds and clicks 5
- Training and practice, as demonstrated by the improvement in cardiac auscultation skills in pediatric residents with training 6
Key Features to Identify
When identifying heart murmurs, key features to focus on include:
- S1 and S2 timing
- Grade and location of the murmur
- Quality of the murmur
- Any extra sounds present
- Changes in murmur characteristics during respiration, Valsalva maneuver, exercise, and other maneuvers 4, 6
Effective Learning Methods
Effective methods for learning heart murmurs include: