From the Guidelines
The terms pansystolic and holosystolic are essentially synonymous in cardiac auscultation, both referring to heart murmurs that occur throughout the entire systolic phase of the cardiac cycle, as stated in the 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease 1. These murmurs begin with the first heart sound (S1) and continue through the entire systole until the second heart sound (S2), without any gaps. The prefix "pan-" means "all" or "entire" in Greek, while "holo-" means "whole" or "complete" in Greek, so both terms convey the same meaning of a murmur lasting the whole systolic period. These murmurs typically indicate significant valvular pathology such as mitral regurgitation, tricuspid regurgitation, or ventricular septal defects, as noted in the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease 1. The continuous nature of these murmurs reflects ongoing turbulent blood flow throughout systole due to abnormal communication between cardiac chambers under different pressures. When auscultating, these murmurs are heard as a continuous "whooshing" sound that begins immediately after S1 and continues without interruption until S2, in contrast to early, mid, or late systolic murmurs that occupy only portions of systole, as described in the 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease 1.
Some key points to consider when evaluating pansystolic or holosystolic murmurs include:
- The timing and duration of the murmur in the cardiac cycle
- The configuration and pitch of the murmur
- The location and radiation of the murmur
- The intensity of the murmur, graded on a scale of 1 to 6
- The presence of any associated symptoms or signs of cardiac disease
It is also important to note that while pansystolic and holosystolic murmurs are often associated with significant valvular pathology, they can also be heard in patients with other cardiac conditions, such as ventricular septal defects or patent ductus arteriosus. Therefore, a thorough evaluation, including a complete medical history, physical examination, and diagnostic testing such as echocardiography, is necessary to determine the underlying cause of the murmur and to guide management, as recommended in the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease 1.
From the Research
Definitions
- Pansystolic murmur: a type of murmur that occurs throughout the entire systolic phase of the cardiac cycle 2
- Holosystolic murmur: another term for pansystolic murmur, used interchangeably in some contexts
Key Differences
- The terms "pansystolic" and "holosystolic" are often used to describe the same type of murmur, which occurs throughout the entire systolic phase of the cardiac cycle
- However, some sources may use "holosystolic" to specifically describe a murmur that occurs throughout the entire systolic phase, with no distinction between the two terms 3
Clinical Significance
- Pansystolic or holosystolic murmurs can be associated with various cardiac conditions, including ventricular septal defects (VSDs) and mitral regurgitation 4, 5
- The diagnosis and management of these conditions depend on the size and anatomical associations of the anomaly, patient's age, and local diagnostic and interventional expertise 6
Murmur Characteristics
- Pansystolic or holosystolic murmurs typically have a uniform pitch and are heard throughout the entire systolic phase of the cardiac cycle
- They can be associated with other cardiac findings, such as diastolic murmurs, and may require further evaluation and management 2