Conversely, a holosystolic murmur begins with or immediately after the S1 heart sound and extends up to the S2, ... “blowing” holosystolic murmur best heard at the apex.

Tricuspid insufficiency is a harsh, holosystolic murmur heard best at the left lower sternal border. This murmur can radiate to the axilla in severe pulmonary hypertension.

Conversely, a holosystolic murmur begins with or immediately after the S1 heart sound and extends up to the S2, making them difficult, if not impossible, to hear.

Case 005 - Patient With Dyspnea and a Heart Murmur December 13, 2001. History. A 59-year-old female with exertional dyspnea and a loud holosystolic murmur at the apex presented with sinus rhythm.