Systolic tremor is a small vibration sensation felt in the palm of the hand during palpation, similar to the respiratory tremor felt in the larynx of cats, also known as feline wheezing. The mechanism of tremor is the same as that of interstitial tremor. It is caused by the flow of blood through a narrow caliber or in an abnormal direction to form a vortex that causes vibrations in the valves, vessel walls, or walls of the heart chambers to be transmitted to the chest wall. When tremor is detected, the site and source (valve, large vessel, or septal defect) should be determined first, followed by the phase of the cardiac cycle (systolic, diastolic, or continuous), and finally, its clinical significance should be analyzed. What are the causes of systolic tremor symptoms? 1, Systolic tremor at the second intercostal space on the right edge of the sternum, commonly associated with aortic stenosis. 2.Systolic tremor at the second intercostal space on the left edge of the sternum is commonly associated with pulmonary stenosis. 3.Systolic tremor between the third and fourth ribs on the left edge of the sternum, commonly associated with ventricular septal defect 4.Systolic tremor in the apical region, commonly associated with severe mitral valve closure insufficiency. Diagnosis 1. The patient’s medical history should be taken in detail. Such as the age when the tremor was first detected and the presence of concomitant symptoms, etc. Symptoms such as palpitations and shortness of breath and fever that appear early in life are the main points of diagnosis of congenital heart disease. Aortic stenosis and mitral stenosis are mostly rheumatic in nature. Patients usually develop around 20-40 years of age and may have a history of irregular fever and arthritis. If tremors are found in the elderly, stenosis due to aortic valve calcification should be considered if there is no clear previous history of heart disease. 2.Physical examination. Patients with congenital heart disease may have dysplasia with short stature and group trabecular fingers. Patients with rheumatic heart valve disease may have red and swollen deformed joints. Patients with unclosed arterial ducts may have a watery pulse murmur. Peripheral vascular signs such as capillary pulsation can be heard in all diseases in the corresponding areas.