A 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 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 tremor is found in the elderly with no clear previous history of heart disease then stenosis due to calcification of the aortic valve should be considered. Patients with congenital heart disease may have dysplasia with short stature and group trapezoid fingers. 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 with pathological murmurs in the corresponding areas. Systolic tremor differential diagnosis: Systolic murmur is the most common clinical murmur, which can be functional or organic, with functional being the most common type of cardiac murmur. A cardiac murmur is an abnormal sound produced by the vibration of the ventricular wall, valves, or vessel walls at the point where the heart sounds with additional heart sounds, due to the turbulence of blood in the heart or blood vessels during systole or diastole. In mitral valve insufficiency, during left ventricular systole, blood returns from the left ventricle to the left atrium and produces a murmur, and the resulting systolic murmur is transmitted to the left axilla. Any factor that increases the pressure step difference between the left ventricle and left atrium during systole can enhance the murmur. During inspiration, the intrathoracic pressure decreases (less than atmospheric pressure), the right ventricle pumps less blood into the pulmonary circulation, and the left ventricular filling volume decreases, and the systolic left ventricular pressure step difference decreases due to the influence of the thoracic pressure, resulting in a relative decrease in the amount of counter bleeding and a weaker murmur. During expiration, the thoracic pressure rises (greater than atmospheric pressure), the right ventricle pumps more blood into the pulmonary circulation, the left ventricular filling volume also increases, and at the same time, influenced by the thoracic pressure, the pressure step difference between the left ventricle and the left interventricular pressure during systole relatively rises, the volume of regurgitant blood relatively increases, and the murmur increases.
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