Holosystolic Murmur

What is a holosystolic murmur?

A holosystolic murmur is a sound your healthcare provider hears through a stethoscope when you have an issue with a heart valve or the wall between your heart’s lower chambers. While your healthcare provider hears your heartbeat, they’re also hearing an abnormal sound of blood that isn’t flowing smoothly.

The best place to hear some types of holosystolic murmurs may be at the apex of your heart, which is at the bottom of your heart; or at the lower left sternal border, which is closer to the center of your chest than the apex.

A holosystolic murmur, or pansystolic murmur, happens during the time in your heartbeat when your heart is pushing blood out to your body.

You may also hear your healthcare provider describe your murmur with a number from one to six. This describes how loud your murmur is, or its “grade.” The loudest murmurs get the highest numbers, but that doesn’t mean they’re the worst.

If your healthcare provider can place their hand over your heart and feel your murmur, that’s known as a “thrill.”

A holosystolic murmur itself isn’t dangerous, but it’s a sign of a condition that you may need to fix.

What are the most common causes of a holosystolic murmur?

A heart valve that doesn’t close correctly can cause a holosystolic murmur.

If a valve doesn’t close completely, blood can slide backward to the place where it just left. This “leaky valve” problem is called:

• Mitral regurgitation, from rheumatic fever or other things damaging your mitral valve.
• Tricuspid regurgitation, which affects your heart’s tricuspid valve.

Usually, blood flows one way through your heart’s four chambers. Valves between the chambers act like doors between rooms. Like elevator doors that let people in and out, heart valves open and close to let blood in and out at specific times. When there’s a problem with one of these valves, it affects how your blood moves through your heart.

Mitral regurgitation can raise the blood pressure in your left atrium (one of your heart’s upper chambers) and in your pulmonary veins that take blood from your lungs to your heart. In bad cases, this pressure can cause fluid to collect in your lungs, eventually leading to heart failure.

Blood also has trouble getting through a narrow valve (a valve with stenosis), and this also can cause a murmur.

Other causes of a holosystolic murmur include:

• Ventricular septal defect, a hole in the wall between the left and right sides of your heart’s lower chambers. Some babies have this problem at birth because the wall didn’t come together before birth.

How is a holosystolic murmur treated?

Instead of treating the murmur itself, your healthcare provider will treat the cause of it.

If one of your heart valves is leaking, your healthcare provider may prescribe anticoagulants or diuretics. If that’s not enough, they can do surgery to repair or replace your valve.

Your new heart valve may be:

• Mechanical (a combination of metal and plastic).
• Bioprosthetic (made with a pig’s or cow’s heart valve).

Bioprosthetic valves last about 10 to 12 years, but you don’t need to take an anticoagulant for life (to prevent blood clots) as you do with mechanical ones.

For either kind of replacement valve:

• You’ll need to take antibiotics before having dental work and medical procedures. This prevents a heart valve infection called endocarditis.
• Your healthcare provider will use echocardiograms and computed tomography (CT) to check your valve regularly.

For a valve that’s too narrow, your healthcare provider can do a balloon valvuloplasty during a cardiac catheterization. They put a catheter with a deflated balloon through your vein and then into your valve. Once it’s in your valve, they expand the balloon to make your valve wider. Then, they remove the balloon.

For a ventricular septal defect, treatment may include medicine to relieve symptoms or surgery to close the hole in the wall between your heart’s lower chambers.

For dilated cardiomyopathy, treatments may include:

• Valve repair or replacement.
• Defibrillator.
• Pacemaker.
• Coronary artery bypass graft surgery.
• Ventricular assist device or heart transplant for advanced cases.

What can I do at home to treat a holosystolic murmur?

If dilated cardiomyopathy is causing your holosystolic murmur, you can:

• Only allow yourself to have a certain amount of fluids and salt each day.
• Let your healthcare provider know about changes in your blood pressure or pulse.

How can a holosystolic murmur be prevented?

You may be able to prevent a ventricular septal defect in your baby by avoiding alcohol and the antiseizure medications phenytoin and valproic acid (Depakote® or Depakene®) while you’re pregnant.

You may be able to prevent some causes of dilated cardiomyopathy, including:

• Drug and alcohol use.
• Infections.
• Diabetes.
• Heart attack.
• High blood pressure.

When should a holosystolic murmur be treated by a doctor or healthcare provider?

Some holosystolic murmurs don’t have symptoms and people don’t even know they have a murmur. Other murmurs aren’t as mild and can give you noticeable issues.

Contact your healthcare provider if you’re having:

• Trouble breathing.
• Heart palpitations.
• Chest pain.
• Shortness of breath.
• Swelling in your feet and legs.

A note from Cleveland Clinic

Your healthcare provider listens to your heart during check-ups and can find a murmur then, so be sure you and your family go to your regular appointments. It’s always better to find a health problem early, before it gets worse. If you need treatment for the cause of your holosystolic murmur, consider your choices carefully and ask questions about anything you don’t understand. If you need heart surgery, it’s best to choose a heart surgeon who has a lot of experience with the type of surgery you need.