Diastolic tremor in the apical region is most often seen in mitral stenosis, where the valve stenosis affects the flow of blood through the heart, so that the blood flow does not pass through the stenotic valve affecting the amount of cardiac output and no effective atrial contraction is produced by the tremor. The main signs of valvular stenosis are diastolic tremor, systolic murmur, and mid- to late-diastolic murmur when the apical part of the heart is palpated with diastolic tremor. In the absence of effective atrial contraction and diminished tremor, other causes of diastolic tremor in the apical region include aortic valve insufficiency and in patients with congenital heart disease. Diastolic tremor is the main sign of heart valve disease and can be used as a basis for differential diagnosis. Clinical manifestations, electrocardiography, cardiac ultrasound, auscultation and palpation can identify various heart diseases.
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