for the record, there are 2 small corrections: (1) The slides show two S1's marked on the visual representation of the murmurs. Obviously, it should say S1 and S2. (2) Mitral Stenosis is a diastolic murmur, however, our video incorrectly depicts it as being systolic on the slide about MS (the visual representation). Also (not a correction), remember that Aortic Regurgitation is described as a "blowing" murmur. That's all. The video is still bomb diggity awesome if I may say so myself
Hey Dirty, so I believe [Plz correct me if I'm wrong] you need to add a point in the case of Afterload. The exceptions should include HOCM, MVP, and Aortic Stenosis b/c an Increase in Afterload (Handgrip) also decreases the blood flow through the stenotic valve, AS. Great video series. Thanks for the reviews! Also great Pneumonic is RILE Right sided-Inspiration Left sided-Expiration
Please ,do make a video about ASD,VSD and PDA.I follow your channel from Turkey.And I really need to learn it.I don't understand clearly when I read it from medical books.Please,help me🙏
A professor at my school came up with a pretty great memory hook that I thought I would share: "(h)ARD fall, ASS bump, MSD (missed) u, MRS thru" ARD = Aortic Regurg, Diastolic; fall = decrescendo \ ASS = Aortic Stenosis, Systolic; bump = crescendo-decrescendo / \ MSD = Mitral Stenosis, Diastolic; u = decrescendo-crescendo \_/ MRS = Mitral Regurg, Systolic; thru = holo-systolic --- If you take a hARD fall, you'll have an ASS bump, if someone says they MSD you, then you and your MRS are thru Pulmonic follows same rules as aortic (in pulmonic area), Tricuspid follows same rules as mitral (in tricuspid area)
Used this video last year for step 1 and it came in super handy. Studying for step 2 now and I'm still getting questions right from what I learned on here a year ago. Just wanted to come back and say how clutch y'all are. Seriously. Thanks for doing what you do!
You are far better, in terms of quality and details, than most of the lecturers in medical school. I think the lecturer should just turn your video during lecture time and leave. This will benefit all of us.
Have been going madd for hours trying to understand WHY HOCM is louder with decreased pre-load. None of these board review books or videos have an answer. U-World just says “that’s how it is”. Finally, a video that explains it in somewhat of an understandable concept. Understanding WHY always helps, and this video at least attempts to do that. Thank you guys, great content, keep up the great work!
After going to b&b, USMLE Rx,UW, FA i almost gave up on understanding systolic vs diastolic murmurs and was ready to just memorize them without logic.THANK YOU DIRTY, its soo simple to understand now!Legit took me just 5 minutes to understand the entire thingy. This channel has to be a standard recommendation for all those preparing for STEP1.PERIOD.
Seriously though.... I always thought it would be better just to get the resources and study independently for Step 1 for two years instead of attending pointless lectures. Students would have higher scores with a fraction of the debt.
When medical students across borders were in distress .....but in desperation to understand concepts.....GOD CREATED DIRTY USMLE FOR THEIR SAVIOUR ❣️❣️❣️❣️❣️
You guys are awesome! A mnemonic I got from a friend that you guys might like: “if your arms were chopped into parts, you will probably die” so ARMS PRTS represent all the DIastolic murmurs.
To add to this: You know that creepy thing where people whisper or eat gherkins into the microphone? It's called ASMR... P.S - it's Too Rude. Therefore ASMR PSTR for systolic.
I'm only a minute or so into this video and I am absolutely blown away. I always struggle with this topic and it causes a lot of anxiety when answering practice questions, but this has made my life so much easier. Thank you so much!!!
I have been legit learning murmurs since morning and I have learned more in 22 mins than I did the whole day.I I can't tell you how thankful I am for this.
This is truly a great help for me. Really appreciate your video. MS:questions also come with recent travel history aka immigrants, pregnant women. PDA: cont. machine like murmur. Loudest @s2, best heard @ Lt-infraclavicular area. VSD: loud/harsh/high-pitch holo systolic (pansystolic) murmur. Radiates over Pre-cordium. ||||||||||||||||||| Thanks
Wow dude, in the first ten seconds I listened, you've already exceeded so many other videos. I love the mechanistic "logic" of how/when a sound would be heard. Thanks!
just to be honest if you have a private channel I would register and pay for it ,what you are doing for med students is extremely helpful .God bless you and reward you with all your wishes .
I love you DM. None of my professors were able to explain this clearly. Some of them even get confused when they are talking without thinking. I was always confused by this topic, but now you clarified everything.
Just some more mnemonics Essentially aortic goes with pulmonic and mitral with tricuspid. For aortic - ASs (aortic stenosis systolic) AIDs (alrtic insufficiency (regurge) diastolic) Mitral - MSD (Mitral stenosis diastolic) I've remembered this as Mahinder singh dhoni a famous Indian cricketer MRS - Mitral regurgitation systolic Another for quickly remembering which among mitral/tricuspid is left or right, there's a T when you write a capital R (somewhat if you see it) but not an a M so Tricuspid is Right
Wish this was around when I went to med school 20 years ago. Nevertheless, it is helping for re-certification of the Boards. Thanks so much. You are incredible!
this video nailed it with learning about the different murmurs.. this will definitely help me understand the etiology and functional component of each murmur while studying for HMPR during the advanced nurse practitioner program ..
Good lecture. Just one correction: Opening snap of Mitral stenosis occurs during diastole and therefore it should come after S2, not S1 as you have depicted in your slide.
Tengo mi step2ck en una semana y este es el MEJOR video que que visto para soplos !!! I’m taking my step 2ck in a week and this is the BEST video that have seen about murmurs!!!
This is absolutely genius 👏 🙌 you literally not only save our career but the lives of our fure patients also ❤❤❤❤❤❤ thank youuuuuuuuuuuuuuuuuuu ❤❤❤❤❤❤❤❤❤❤❤
The use of two simple mnemonics may help differentiate systolic and diastolic murmurs; PASS and PAID. Pulmonary and aortic stenoses are systolic while pulmonary and aortic insufficiency (regurgitation) are diastolic. Mitral and tricuspid defects are opposite.
i had learnt Aortic Stenosis and Pulmonary Stenosis are Systolic with the mnemonic AS-S and PuS-Sy ! that way i know MS is not systolic but diastolic !
I enjoy your videos and truly believe you are a gifted educator. However, I think a more accurate description of preload is the volume of blood remaining in the be ventricle prior to filling. I think it’s a more accurate hemodynamic definition. Especially in regards to Starling’s Law.
I heard that the points of hearing heart murmur are(1) regions of sounds(A valve? M Valve? Or?)(2) During diastolic or systolic(3)In special case like MVP, key word or key sounds like click sound. Do you think that it is a good strategy? Or, are there any points to rectify?
I think it is the easiest to remember that aortic stenosis is systolic. From there, you know that the counterpart stenosis is systolic too (pulmonary stenosis is systolic), and that opposite valve's opposite problems are systolic too (mitral & tricuspid regurgitation are systolic). For the rest of the murmors, it is the opposite of what I just said. E.g., mitral stenosis is diastolic as mitral regurgitation is systolic. I hope it helps:)
thanks for the great video! one question -- isn't MVP a regurgitant murmur? In that case, why would it improve with increased afterload, when in general increasing afterload makes regurgitation murmurs worse?
Elli Novatcheva I might be wrong, but I think it’s because increased afterload makes ejection of blood during ventricular systole more difficult, as a result blood keeps accumulating in LV and consequently in LA. Too much blood in LA then push the prolapsed mitral valve( which was prolapsed into LA from its original location of AV junction) back to its previous location, thus reducing the murmur. However, more blood in LA means there must’ve been more regurgitation through MVP, so initially the murmur might increase but only till the blood in LA is sufficient enough to push back the prolapsed valve.
Note: There z always Aortic nd pulmonic together and Tricuspid and Mitral together. And if Aortic regurgitation, Then Mirtal/ Tricuspid - Stenosis. Mnemonic: For DIASTOLIC : DARK = ie. D-DIASTOLIC AR- Aortic Regurgitate
Thank you Dirty USMLE for this nice video presentation. As you've mentioned at the end part of MVP and something in relation to "younger women w/ psychiatric disorder" which is hard to understand why,then i began thinking about "if it has something to do during spontaneous delivery as they trying to push more harder until the baby comes out?" Because it was mentioned "younger woman and not man."
yes, the association is with young women with psychiatric histories. we don't really know why. your explanation seems plausible at first but even when women have never been pregnant or "pushed" they can still have MVP w/ co-morbid psychiatric illness, so I don't know
Do the maneuvers actually make the MVP louder or softer or are they affecting the timing of the midsystolic click (early vs later click), or are both volume and timing being affected?
for the record, there are 2 small corrections:
(1) The slides show two S1's marked on the visual representation of the murmurs. Obviously, it should say S1 and S2.
(2) Mitral Stenosis is a diastolic murmur, however, our video incorrectly depicts it as being systolic on the slide about MS (the visual representation).
Also (not a correction), remember that Aortic Regurgitation is described as a "blowing" murmur.
That's all. The video is still bomb diggity awesome if I may say so myself
Hey Dirty, so I believe [Plz correct me if I'm wrong] you need to add a point in the case of Afterload. The exceptions should include HOCM, MVP, and Aortic Stenosis b/c an Increase in Afterload (Handgrip) also decreases the blood flow through the stenotic valve, AS.
Great video series. Thanks for the reviews!
Also great Pneumonic is RILE Right sided-Inspiration Left sided-Expiration
@@jensonmathew8437 That is correct
You are the chosen one. The neo of medicine. The keeper of mnemonics. The master of medicine.
Please ,do make a video about ASD,VSD and PDA.I follow your channel from Turkey.And I really need to learn it.I don't understand clearly when I read it from medical books.Please,help me🙏
Dirty, you need to make your slides available. I'd pay for that shit.
A professor at my school came up with a pretty great memory hook that I thought I would share:
"(h)ARD fall, ASS bump, MSD (missed) u, MRS thru"
ARD = Aortic Regurg, Diastolic; fall = decrescendo \
ASS = Aortic Stenosis, Systolic; bump = crescendo-decrescendo / \
MSD = Mitral Stenosis, Diastolic; u = decrescendo-crescendo \_/
MRS = Mitral Regurg, Systolic; thru = holo-systolic ---
If you take a hARD fall, you'll have an ASS bump, if someone says they MSD you, then you and your MRS are thru
Pulmonic follows same rules as aortic (in pulmonic area), Tricuspid follows same rules as mitral (in tricuspid area)
I cannot thank you and your professor enough 🤩
Wow thanks
The most beneficial comment I’ve ever read 👍👍well done champ 👍👍👏👏
Thanks Parker Greider
thank you thank you thank you!!!!
Used this video last year for step 1 and it came in super handy. Studying for step 2 now and I'm still getting questions right from what I learned on here a year ago. Just wanted to come back and say how clutch y'all are. Seriously. Thanks for doing what you do!
You are far better, in terms of quality and details, than most of the lecturers in medical school. I think the lecturer should just turn your video during lecture time and leave. This will benefit all of us.
Agree 100%!!
Have been going madd for hours trying to understand WHY HOCM is louder with decreased pre-load. None of these board review books or videos have an answer. U-World just says “that’s how it is”. Finally, a video that explains it in somewhat of an understandable concept. Understanding WHY always helps, and this video at least attempts to do that. Thank you guys, great content, keep up the great work!
After going to b&b, USMLE Rx,UW, FA i almost gave up on understanding systolic vs diastolic murmurs and was ready to just memorize them without logic.THANK YOU DIRTY, its soo simple to understand now!Legit took me just 5 minutes to understand the entire thingy.
This channel has to be a standard recommendation for all those preparing for STEP1.PERIOD.
my god i don't even know what I learned in med school in those long lectures and paying thousands of dollars. We should just pay you instead
Seriously though.... I always thought it would be better just to get the resources and study independently for Step 1 for two years instead of attending pointless lectures. Students would have higher scores with a fraction of the debt.
Yikes. Guessing you guys go to an American med school? Worst education for the worst doctors
Best way to thank you is by NOT skipping the adds 😂
When medical students across borders were in distress .....but in desperation to understand concepts.....GOD CREATED DIRTY USMLE FOR THEIR SAVIOUR ❣️❣️❣️❣️❣️
You guys are awesome! A mnemonic I got from a friend that you guys might like: “if your arms were chopped into parts, you will probably die” so ARMS PRTS represent all the DIastolic murmurs.
What is prts
@@deryasadioglu1115 pulmonic regurge and tricuspid stenosis
To add to this:
You know that creepy thing where people whisper or eat gherkins into the microphone? It's called ASMR... P.S - it's Too Rude. Therefore ASMR PSTR for systolic.
I'm only a minute or so into this video and I am absolutely blown away. I always struggle with this topic and it causes a lot of anxiety when answering practice questions, but this has made my life so much easier. Thank you so much!!!
I have been legit learning murmurs since morning and I have learned more in 22 mins than I did the whole day.I I can't tell you how thankful I am for this.
Amazing... My UWorld scores have been going up thanks to your videos. Thanks!
I was worrying so much about my upcoming cardiology exam and this 22 min video has cleared my confusion so well. Kudos
This is truly a great help for me. Really appreciate your video.
MS:questions also come with recent travel history aka immigrants, pregnant women.
PDA: cont. machine like murmur. Loudest @s2, best heard @ Lt-infraclavicular area.
VSD: loud/harsh/high-pitch holo systolic (pansystolic) murmur. Radiates over Pre-cordium.
|||||||||||||||||||
Thanks
Wow dude, in the first ten seconds I listened, you've already exceeded so many other videos. I love the mechanistic "logic" of how/when a sound would be heard. Thanks!
just to be honest if you have a private channel I would register and pay for it ,what you are doing for med students is extremely helpful .God bless you and reward you with all your wishes .
I passed my step 1. Thank you Dirty medicine you saved a lot of time for me. Your videos are amazing
Step 1 checked, Step 2 checked, recapping it for Step 3. Dirty, you are the OG & a Genius
This video is awesome, I was able to get all of the heart murmur questions on my exam right thanks to this video. I highly recommend! Thanks so much!
Thank you for all that you do for making notoriously difficult concepts easy to understand and memorable.
I love you DM.
None of my professors were able to explain this clearly.
Some of them even get confused when they are talking without thinking.
I was always confused by this topic, but now you clarified everything.
best cardiology lecture about this topic hands down
thank you so much
After I pass NP boards this friday and secure a job, I promise I will donate. I owe you.
Just some more mnemonics
Essentially aortic goes with pulmonic and mitral with tricuspid.
For aortic - ASs (aortic stenosis systolic)
AIDs (alrtic insufficiency (regurge) diastolic)
Mitral - MSD (Mitral stenosis diastolic) I've remembered this as Mahinder singh dhoni a famous Indian cricketer
MRS - Mitral regurgitation systolic
Another for quickly remembering which among mitral/tricuspid is left or right, there's a T when you write a capital R (somewhat if you see it) but not an a M so Tricuspid is Right
I finally understand heart murmurs. Cardiac is not my forte I am so glad I found this
Thank you sm!!! Taught my 4 hr lecture in 22 minutes!!
Thank you for this lecture. I finally got an understanding of this concept that has been giving me tough times.
Wish this was around when I went to med school 20 years ago. Nevertheless, it is helping for re-certification of the Boards. Thanks so much. You are incredible!
If you listened this 20 years ago, it would be same like it was 20 years ago. If you listen sth you already know is easy to understand.
Thanks million, will be reviewing for NP boards in January and I will be reviewing all your videos. Thank you sooooo much.
Thanks to your videos i now finally understand a lot of concepts I didn’t in med school. I will forever be grateful
I only wish I'd have watched this sooner! I struggled with this for YEARS and this vid is what finally put it together for me. Thanks so so SO much!
Hey, good job. This is far better than all the long lectures I have attended. Concise and loaded.
this video nailed it with learning about the different murmurs.. this will definitely help me understand the etiology and functional component
of each murmur while studying for HMPR during the advanced nurse practitioner program ..
Good lecture. Just one correction: Opening snap of Mitral stenosis occurs during diastole and therefore it should come after S2, not S1 as you have depicted in your slide.
Also both bars in all diagrams are labelled "S1"
Tengo mi step2ck en una semana y este es el MEJOR video que que visto para soplos !!!
I’m taking my step 2ck in a week and this is the BEST video that have seen about murmurs!!!
Eduardo Moya Que te vaya bien! Stay determined!
Eduardo Moya. Muy buena suierte. Good luck 🐞
Eduardo Moya, Cómo saliste? Tengo el mío en 4 meses.
You absolute legend, Ijust got wrecked with amboss cardio but now I can understand this stuff. Much appreciated
I was struggling with this topic. You guys made it super easy! Thanks.
I liked this video. Very good tips!! Alas during my medical student time we were learning it the hard way and forgetting the easy way!!
this video helped me understand these murmurs tremendously! cannot thank you enough!!
mnemonic for systolic murmurs: V TRAPS MR. P (it's dirty)
VSD
Tricuspid Regurg
Aortic/Pulmonic Stenosis
Mitral Regurge/Prolapse
This is absolutely genius 👏 🙌 you literally not only save our career but the lives of our fure patients also ❤❤❤❤❤❤ thank youuuuuuuuuuuuuuuuuuu ❤❤❤❤❤❤❤❤❤❤❤
Aortic regurgitation = seen in bicuspid aortic valve OR Aortic root dilation
-Pathophysiology = Backflow from aorta into left ventricle -> ↑ LV end-diastolic volume-> eccentric hypertrophy (↑ SV & CO) -> LV dysfunction → decompensated heart failure
-C/P = decrescendo early diastolic murmur, widened pulse pressure; Rapid rise-rapid fall ("water-hammer") pulsation (hyperdynamic), Abrupt carotid distension & collapse, "pistol-shot" femoral pulses
tysm. tomorrow is my exam & this is the last topic that im reviewing. plis pray for me guys.
The use of two simple mnemonics may help differentiate systolic and diastolic murmurs; PASS and PAID. Pulmonary and aortic stenoses are systolic while pulmonary and aortic insufficiency (regurgitation) are diastolic. Mitral and tricuspid defects are opposite.
Words can't explain how grateful I am!
ur really a MVP in field of medicine lectures..as always u nailed it
currently on dedicated, this is amazing!!!!!!!!! thank you so much!!! super clear and helpful!!
i had learnt Aortic Stenosis and Pulmonary Stenosis are Systolic with the mnemonic AS-S and PuS-Sy !
that way i know MS is not systolic but diastolic !
Lol! One hell of a Mnemonic.
@@sagarjigar up
🤣
**Systolic vs. Diastolic**
Mr. Ass (Mitral Regurgitation- Aortic Stenosis- Systolic)
Ms. Ard (Mitral Stenosis- Aortic Regurgitation- Diastolic)
excellent video, thank you so much. You have helped me a lot for my cardio exam
May the person get all the blessings in his life who has made this easy for us!
I have to like every video even before I watch it because I just know it's going to be good
You dropped this: 👑
A million of thanks! After all those years I finally understand!
Thank you so much for putting your time, dedication and brains into making this video. So useful!!
To win MVP, your team has to click with the crazy chick
To win MVP your team has to click and myx with the crazy chick
Vvvvvv'vvvvvvvvvvvvvvvv
Thanks a ton, please please keep making more lectures ❤
MR.AS(S) = Mitral Reg. Aortic Stenosis -Systole
MS.AR(D) = Mitral Sten. Aortic Reg - Diastole
I cannot even begin to thank you!!!! Thats just amazing!!!!
You made my work so easy by such a phenomenal explanation! Thank you!
I enjoy your videos and truly believe you are a gifted educator. However, I think a more accurate description of preload is the volume of blood remaining in the be ventricle prior to filling. I think it’s a more accurate hemodynamic definition. Especially in regards to Starling’s Law.
This video is such a good review! Thank you so much!
I heard that the points of hearing heart murmur are(1) regions of sounds(A valve? M Valve? Or?)(2) During diastolic or systolic(3)In special case like MVP, key word or key sounds like click sound.
Do you think that it is a good strategy? Or, are there any points to rectify?
I think it is the easiest to remember that aortic stenosis is systolic. From there, you know that the counterpart stenosis is systolic too (pulmonary stenosis is systolic), and that opposite valve's opposite problems are systolic too (mitral & tricuspid regurgitation are systolic). For the rest of the murmors, it is the opposite of what I just said. E.g., mitral stenosis is diastolic as mitral regurgitation is systolic.
I hope it helps:)
thanks for the great video! one question -- isn't MVP a regurgitant murmur? In that case, why would it improve with increased afterload, when in general increasing afterload makes regurgitation murmurs worse?
Elli Novatcheva I might be wrong, but I think it’s because increased afterload makes ejection of blood during ventricular systole more difficult, as a result blood keeps accumulating in LV and consequently in LA. Too much blood in LA then push the prolapsed mitral valve( which was prolapsed into LA from its original location of AV junction) back to its previous location, thus reducing the murmur. However, more blood in LA means there must’ve been more regurgitation through MVP, so initially the murmur might increase but only till the blood in LA is sufficient enough to push back the prolapsed valve.
U r awesome...murmers have been my weakness...i am finally confident i can get them rgt frm now...thankyouuuu somuchhhhh
truly lucky to have access to this
Note:
There z always Aortic nd pulmonic together and Tricuspid and Mitral together.
And if Aortic regurgitation,
Then Mirtal/ Tricuspid - Stenosis.
Mnemonic: For DIASTOLIC : DARK = ie.
D-DIASTOLIC
AR- Aortic Regurgitate
Thank you for turning the light bulb on for me.. I just got it.. Mucha gracias, danke schon, asante sana, merci!!!!
I can't even thank u enough for this amazing video..lts really very helpful ❤
oh my god! I love your videos and all the tricks that you teach us. You are amazing!
way i remember is that Semilunar valves (aortic and pulmonic) Stenosis in Systoly from there you can derive the rest
It’s a treasure Channel❤❤❤
Awesome videos and explanation sir
Thank you Dirty USMLE for this nice video presentation. As you've mentioned at the end part of MVP and something in relation to "younger women w/ psychiatric disorder" which is hard to understand why,then i began thinking about "if it has something to do during spontaneous delivery as they trying to push more harder until the baby comes out?" Because it was mentioned "younger woman and not man."
yes, the association is with young women with psychiatric histories. we don't really know why. your explanation seems plausible at first but even when women have never been pregnant or "pushed" they can still have MVP w/ co-morbid psychiatric illness, so I don't know
Thank you! Finally understand how murmurs increase and decreade!
LITERALLY A LIFE SAVER ❤️❤️❤️
I was so confused about the murmurs. Thanks a lot!
Anyway you could do a heart embryology video? :) (Septum primum and what not ahhh) Thanks for making these videos!!!
IS THIS WHAT GOD SOUNDS LIKE. THANK YOU BASED GOD.
Bundle of thanks for sharing these amazing videos...
keep up with fantastic work doc
Explained it so well. Thank you so much!
Absolutely stunning, Thankyou so much 🎉
murmurs are beautifully explained
What amazing easy and fabulous way to learn how murmurs looks like 👍... a silly simple question; what AKA stands for?
Do the maneuvers actually make the MVP louder or softer or are they affecting the timing of the midsystolic click (early vs later click), or are both volume and timing being affected?
My 2 d echo result is "thickened anterior mitral valve with no restriction in motion ..is it dangerous ?
OMG. YOUR VIDEO IS SO AMAZING! Thank you endlessly! 😊😊 23/3/2019
you are a genius, thanks for all explications in this video and I hope that more people in medical school will subscribe to your channel.
Wow the maneuvers finally make sense now. Thank you Dirty!!
thank you so much- just seeing this video and it has helped me !!
this was so so helpful! THANK YOU!
Another amazing video. Thank you so much!
You know Dirty, you da real MVP!!!!!
Amazing video! hope you continue to post new ones!
You made it look so easy! Thank you. Very useful ❤
But the murmur of pulmonic stenosis, a right-sided defect, is decreased with inspiration. Now my head is ALL messed up! Am I missing something here?
Thank youu!! the best mnemonics so far!
in addition to HOCM and MCP, apparently atrial myxomas have the same effect ... learned this from an NBME exam.