Systolic tremor is a small vibrating sensation felt in the palm of the hand during palpation, similar to the respiratory tremor felt in the throat of a cat, also known as feline wheezing. How is systolic tremor diagnosed? Cardiovascular ultrasonography, ambulatory electrocardiogram (Holter monitoring). I. Medical history The patient’s medical history should be asked in detail. For example, 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 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. Physical examination Patients with congenital heart disease may have dysplasia, short stature and group trapezoid finger. Patients with rheumatic heart valve disease may have red and swollen joints. Patients with arteriovenous ductus arteriosus may have watery pulse murmur. Peripheral vascular signs, such as capillary pulsation, can be heard in all diseases with pathological murmurs at the appropriate sites.