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A critical part of the physical examination is auscultation of the heart. Auscultation is fun, but the heart sounds are hard to learn, hard to teach and hard to remember without constant practice. As a teacher, I have struggled to make them easier to hear and to remember. Sure, the first 2 heart sounds are easy, once you get the timing right. But gallops are tougher. As a student, I could never remember the correct pronunciation of “Kentucky” or “Tennessee” as memory aids to describe the third and fourth heart sounds, perhaps in part because they had no relevance to my own experience.
Quite a few years ago, I began teaching Canadian mnemonics for the extra heart sounds. Canadian students understand and remember these memory aids because they are relevant to them and fun. Before I leave clinical practice, I wish to share these little aids.
The third heart sound (S3) sounds like “Montreal,” pronounced as only the Anglophones mispronounce it, with the last syllable very soft (MON TRE al). The presence of this heart sound means the ventricle is like that city: dilated and congested (this is to be taken in fun only, please; I love Montréal). The fourth heart sound (S4) sounds like “Toronto,” with emphasis on the middle syllable (tor ON to). The presence of this heart sound means that the ventricle is stiff and noncompliant, just like that city (sorry, Toronto). When the ventricle is in serious trouble, both S3 and S4 are present, sounding like “Saskatchewan.” Enough said.
My students and my patients have had fun with these mnemonics and they do remember what they stand for. Patients even ask, “Do I still sound like Montreal [or Toronto] today?”