HOLOSYSTOLIC MURMURS

Question 1

Regurgitant flow continues throughout systole, and even after aortic valve closure (holosystolic)
High pitched; best heard at apex with the diaphragm in the left lateral decubitus position

Radiation depends upon the murmur intensity, which may be variable; direction of radiation follows the
direction of the regurgitant jet into the left atrium

If severe primary MR or a dilated CM with secondary MR, there may be an S3 gallop due to the high
antegrade flow across the mitral valve, and findings of pulmonary hypertension and right heart failure

Answer 1

*Mitral regurgitation

Question 1

What are the holosystolic murmurs?

Answer 1

*Mitral regurgitation
*Tricuspid regurgitation (most often secondary to PAH)
Ventricular septal defect

Question 2

Holosystolic murmur best heard with the diaphragm of the stethoscope along the left or right sternal
border, and may radiate to the epigastrium

*During inspiratory phase of respiration, there is increased venous return and RV volume -> augmented regurgitant flow -> increased intensity of the murmur

(Carvallo’s sign, aka Rivero-Carvallo’s sign)

Answer 2

*Tricuspid regurgitation (most often secondary to PAH)

Question 3

Holosystolic murmur if RV pressure < LV pressure throughout systole, resulting in a continuous left-toright
shunt; best heard left 3rd, 4th, 5th intercostal spaces; wide area of radiation; often highly pitched,
can be so loud (with thrill) and block out S2

Answer 3

Ventricular septal defect