Holosystolic murmur are a type of heart murmurs diagnosed by doctors. Heart murmurs are sounds heard during the auscultation (listening with the stethoscope during the physical examination). Murmurs result either from the sound of back flow of the blood through an injured or non-functional valve (insufficiency) or from the sound of the flow through a stenosed (narrowed) valve. Such murmurs can be found in pathological conditions.
The murmur can be defined by different qualities: the location, the timing, the duration, the form (shape), the quality and the grade.
The location gives us indications about which structure is failing. According to it we can determine whether the mitral valve, the tricuspid valve or the ventricular septum are injured or non-functional.
Holosystolic murmur timing:
The timing is of crucial importance for the diagnosis. A systolic murmur is a murmur taking place during the systole, which is the period when the heart contracts. It can be associated with mitral or tricuspid insufficiency or even with a ventricular septal defect.
Holosystolic murmur means that it occurs throughout the whole systole (from the first heart sound- S1 – to the second one- S2); it is usually associated with regurgitation.
Holosystolic murmur can have different forms over the systole. It intensifies upon inspiration (Carvallo’s sign) in tricuspid insufficiency. There is no intensification with inspiration in the mitral regurgitation. The shape can be important to figure out the pathology from the differential diagnosis (for instance, a rhomboid shaped systolic murmur will be relevant for aortic stenosis).
We can describe to holosystolic murmur different acoustic qualities, such as high pitched, harsh or rumbling.
The grade refers to the intensity of the sound. It ranges from one to six (grade 1 being the quietest one, and grade 6 being very easy to hear, sometimes even without the stethoscope).
In tricuspid insufficiency the murmur is due to the regurgitation of blood through the tricuspid valve. The injury can be due to pulmonary hypertension (the most common cause), bacterial endocarditis or old right ventricular infarction. It can be heard over the 4th and 5th left intercostal space. The holosystolic murmur is not enough to diagnose tricuspid insufficiency on its own. A very common sign of this pathology is the visible pulsation of the jugular vein on the neck.
Mitral regurgitation of holosystolic murmur.
Mitral regurgitation is secondary to the increase of pressure in the left ventricle which causes the blood to flow back to the left atrium during the contraction of the left ventricle. The murmur is heard at the apex, radiates to the left axilla and is harsh. The insufficiency can be either acute (due to papillary muscle dysfunction or valve leaflet perforation) or chronic (due to rheumatic valve damage or collagen diseases, i.e.). The additional findings are a diminished first sound over the mitral area, a widely spread second sound and a left ventricular gallop.
Holosystolic murmur in ventricular septal defect is caused by the blood flowing from the left ventricle to the right one. This is due to a hole in the ventricular wall, usually acquired in a congenital way.