From the Guidelines
A holosystolic murmur in ventricular septal rupture occurs due to the continuous flow of blood from the left ventricle to the right ventricle throughout systole, resulting from the pressure gradient between these chambers, as described in the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction 1. This phenomenon happens because when the ventricular septum ruptures, it creates an abnormal opening between the ventricles, allowing blood to shunt from the left ventricle, which has higher pressure, to the right ventricle, which has lower pressure, throughout the entire systolic phase. The characteristics of this murmur include:
- Beginning with the first heart sound (S1) and continuing through systole until the second heart sound (S2)
- Being best heard at the left lower sternal border
- Possibly being accompanied by a palpable thrill
- Having an intensity that correlates with the size of the defect and the pressure gradient between the ventricles As noted in the guidelines, ventricular septal rupture is a serious complication that often requires emergency surgical repair, even in hemodynamically stable patients, due to the risk of sudden hemodynamic collapse 1. Key points to consider in the management of ventricular septal rupture include:
- The importance of prompt recognition and treatment to prevent further complications
- The role of temporizing medical treatment, such as inotropic and vasodilator agents, and the use of intra-aortic balloon pump (IABP) when needed
- The potential for percutaneous closure as a less invasive option, although experience with this approach is limited and further technical developments and prospective trials are required to identify the best candidates for this treatment 1.
From the Research
Holosystolic Murmur in Ventricular Septal Rupture
- A holosystolic murmur is a type of heart murmur that occurs throughout the entire systolic phase of the heartbeat.
- In the context of ventricular septal rupture, a holosystolic murmur is often heard due to the abnormal flow of blood from the left ventricle to the right ventricle through the ruptured septum 2, 3, 4.
- The murmur is typically loud and pansystolic, meaning it occurs throughout the entire systolic phase, and is often accompanied by other symptoms such as chest pain, shortness of breath, and fatigue.
- The presence of a holosystolic murmur in ventricular septal rupture is a significant finding, as it indicates a large left-to-right shunt and significant hemodynamic compromise 2, 4.
- The diagnosis of ventricular septal rupture is often made using a combination of clinical findings, including the presence of a holosystolic murmur, as well as imaging studies such as echocardiography and cardiac catheterization 3, 4.
Treatment and Outcomes
- The treatment of ventricular septal rupture typically involves surgical repair, although percutaneous closure may be used as a temporizing measure or for patients who are not candidates for surgery 2, 3, 4.
- The outcomes for patients with ventricular septal rupture are generally poor, with high mortality rates reported in several studies 2, 3, 4.
- However, prompt diagnosis and treatment can improve outcomes, and surgical repair remains the treatment of choice for most patients 2, 4.
Note: The study 5 is not relevant to the topic of holosystolic murmur in ventricular septal rupture.