MS ARD
Diastolic Murmurs
What you hear between S2 and S1 — always pathologic until proven otherwise.
On the AANP exam, any murmur that falls between S2 and the next S1 is diastolic, and diastolic murmurs are pathologic until proven otherwise. MS ARD captures the two that come up most often: Mitral Stenosis (low-pitched diastolic rumble at the apex, opening snap, often history of rheumatic fever or atrial fibrillation) and Aortic Regurgitation (early decrescendo blowing diastolic murmur at the left sternal border, wide pulse pressure, water-hammer pulse). Both warrant echo and cardiology referral. Boards loves the dynamic maneuvers — leaning forward at end-expiration accentuates AR — so know the bedside tricks alongside the murmur character itself.
- MSMitral StenosisOpening snap + low-pitched diastolic rumble at apex. Best heard in left lateral decubitus position.
- ARAortic RegurgitationHigh-pitched early diastolic blowing at LUSB. Best heard leaning forward after expiration.
- DDiastolic (descriptor)All diastolic murmurs warrant workup — none are physiologic.
Clinical Context
Diastolic murmurs occur between S2 and S1 — during ventricular filling. Unlike systolic murmurs (some are innocent), ALL diastolic murmurs are pathologic and warrant echo.
Two heavily tested: Mitral Stenosis (the classic rheumatic heart disease sequela — pair with the JONES criteria mnemonic) and Aortic Regurgitation (may present with widened pulse pressure, water-hammer pulse, de Musset head bob, Corrigan pulse). The AANP loves pairing a diastolic murmur with a history clue: recent dental work + new murmur = endocarditis; untreated strep in childhood + new murmur = rheumatic MS.
Related Mnemonics
- 5 T's — Cyanotic Congenital Heart Defects
- 6 P's — Acute Limb Ischemia
- CHA₂DS₂-VASc — Stroke Risk in Non-Valvular Atrial Fibrillation
- HAS-BLED — Bleeding Risk on Anticoagulation
- MR. PASS MVP — Systolic Murmurs
Sources
Ready to practice?
1,500+ AANP-style questions with rationales — free trial.