What is the diagnosis for a holosystolic (entire systolic interval) murmur?

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Last updated: April 27, 2025View editorial policy

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Differential Diagnosis for Holosystolic Murmur

  • Single most likely diagnosis
    • Mitral Regurgitation: This is the most common cause of a holosystolic murmur, resulting from the incomplete closure of the mitral valve, allowing blood to flow back from the left ventricle into the left atrium during systole.
  • Other Likely diagnoses
    • Tricuspid Regurgitation: Similar to mitral regurgitation but involving the tricuspid valve, where blood flows back from the right ventricle into the right atrium during systole.
    • Ventricular Septal Defect (VSD): A defect in the septum between the ventricles can cause a holosystolic murmur due to the flow of blood from the left ventricle to the right ventricle during systole.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Ruptured Sinus of Valsalva: Although rare, this condition involves the rupture of an aneurysm of the sinus of Valsalva into an adjacent cardiac chamber, leading to acute heart failure and potentially life-threatening if not promptly diagnosed and treated.
    • Traumatic VSD: A ventricular septal defect caused by trauma, which can lead to severe and potentially life-threatening complications if not recognized and managed appropriately.
  • Rare diagnoses
    • Ebstein's Anomaly: A congenital heart defect involving the tricuspid valve and right ventricle, which can cause a holosystolic murmur due to tricuspid regurgitation.
    • Congenital Mitral Regurgitation: A rare condition where mitral regurgitation is present from birth, often due to abnormalities in the mitral valve apparatus.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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