Disease of the Heart Valves

Holosystolic murmur and it’s causes

Last updated on October 1st, 2020

What is a Holosystolic murmur?

Below article deals with the introduction to holosystolic murmur and their causes along with their explanations.

What is a heart murmur?

When you put a stethoscope near the chest wall, you can hear vibrations that are of variable durations. These series of vibrations coming from heart or the great vessels are murmurs.

How are murmurs caused?

Murmurs are caused due to the disease or abnormal working of the cardiac valves and structures. This results in the turbulent blood flow in the heart called murmurs.

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What is a systolic murmur?

The murmurs that start either during the first heart sound or after the first heart sound and end during or before the second heart sound are systolic murmurs.

What is a holosystolic murmur?

Holosystolic murmurs are the murmurs that start at the first heart sound and continue to be audible at the second heart sound. You can have a look at the phonocardiogram to know more. Holosystolic murmurs are generally high pitched.

The major causes of holosystolic murmurs include tricuspid regurgitation, ventricular septal defect and mitral regurgitation.

What is tricuspid regurgitation?

When the tricuspid valve leaflets degenerate, severe tricuspid regurgitation is caused. The tricuspid regurgitation murmurs may include either the holosystolic murmur or diastolic murmur or can also include both.

Observations of tricuspid regurgitation

You can observe the following things in a tricuspid regurgitation:

– Rectangular and loud pansystolic murmur
– Diamond shaped, brief and rumbling diastolic murmur
– Unsplit second heart sound with normal first heart sound
– Anatomically, enlargement in the right atrium and right ventricle
– There is turbulent blood flow occurring from right atrium to the right ventricle. It is the systolic murmur
– In diastole, brief and turbulent blood flow occurs from the right atrium to the right ventricle. This is because of the accumulation of blood in the right atrium. This forces the blood into the right ventricle during the diastole.

What differentiates a tricuspid regurgitation from mitral regurgitation?

At the lower left sternal border, the tricuspid murmur is heard with it’s maximum intensity. Moreover, the intensity of murmur increases with inspiration. This differentiates a tricuspid regurgitation from a mitral regurgitation.

To know and listen to different heart sounds, Click here –  Heart sounds

What is a mitral regurgitation?

The murmur best audible at the apex region and of high or mid frequency is of mitral regurgitation. There is no increase in the intensity of the murmur of mitral regurgitation with inspiration. This differentiates mitral regurgitation from tricuspid regurgitation.
We present mitral regurgitation and also the severe mitral regurgitation below.

Read here about – Mitral valve disease

Observations of mitral regurgitation

– Rectangular murmur of mid frequency taking up all of the systole
– The second heart sound is single with the normal first heart sound
– Anatomically, there is enlargement in the left atrium and left ventricle
– There is a turbulent blood flow into the left atrium through the mitral valve leaflets that are incompetent.

Observations of severe mitral regurgitation

– There is degeneration of mitral valve leaflets in severe mitral regurgitation.
– There is a wide split in the second heart sound with first heart sound being normal
– Rectangular and loud pansystolic murmur
– Diamond shaped, brief and rumbling diastolic murmur that immediately follows the third heart sound
– Anatomically, there is enlargement in the left ventricle and left atrium
– There is turbulent flow of blood to the left ventricle from the left atrium which is the systolic murmur
– In diastole, there is brief and turbulent flow of blood to the left ventricle from the left atrium. This is due to the accumulation of blood in the left atrium . This forces the blood to the left ventricle during the diastole.

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Ventricular septal defect

It is a congenital condition when there is presence of a hole in the wall separating the left and right ventricles. Due to the presence of a shunt or hole, blood flows abnormally between the right and left ventricles. Along the sternal border, at the third and fourth intercostal spaces, holosystolic murmurs is audible.

There is development of a wall between the right and left ventricle during foetal development. In some people, there is presence of a defect in the wall. Due to this defect, blood keeps flowing between the ventricles and develops a condition named ventricular septal defect.

Observations of ventricular septal defect

– There is unsplit second heart sound along with having normal first heart sound- All of the systole is filled by a medium pitched murmur
– Anatomically, there is enlargement in the right ventricle. An enlargement is also seen in the left atrium
– There is a turbulent blood flow occurring between the right and left ventricles. It flows from the left ventricle to the right ventricle. This takes place through the upper portion of the septum in systolic murmur
– Again there is a turbulent flow of blood from the left atrium to the right ventricle resulting in diastolic murmur

Takeaway

Holosystolic murmur is a type of murmur in which starts at the first heart sound and continue to be audible at the second heart sound. They are generally higher in pitch and the causes may include tricuspid regurgitation, ventricular septal defect and mitral regurgitation. The causes and their murmurs are also explained above that helps to get a good knowledge regarding the causes of holosystolic murmurs.

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