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 a 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 by an analysis of its clinical significance. The following tests are required for systolic tremor: i. Medical history The patient’s medical history should be asked in detail. Such as the age at which the tremor was first detected and the presence of concomitant symptoms, etc. Symptoms such as palpitations and shortness of breath and fever that appear at an early age 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. Physical examination Patients with congenital heart disease may have dysplasia short stature and group trapezoid finger and other manifestations. Patients with rheumatic heart valve disease may have red and swollen 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.