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Since the L ventricle has a higher pressure than the R ventricle, flow during systole occurs from the L to R ventricle, producing the holosystolic murmur. It can be best heard over the left third and fourth intercostal spaces and along the sternal border. It is associated with normal pulmonary artery pressure and thus S2 is normal.
It is best heard at the left upper sternal border. This is the result of an increased volume going through the pulmonary valve. It has association with a fixed, split S2 and a right ventricular heave. Ventricular septal defect (VSD) will present as a holosystolic murmur. One can hear it at the left lower sternal border.
Pansystolic (Holosystolic) murmur along lower left sternal border (depending upon the size of the defect) +/- palpable thrill (palpable turbulence of blood flow). Heart sounds are normal. Larger VSDs may cause a parasternal heave, a displaced apex beat (the palpable heartbeat moves laterally over time, as the heart enlarges).
Also, that blood flowing through a VSD can be heard as a holosystolic murmur at the lower left sternal border. If it’s a small VSD, it might be asymptomatic. As the size of the VSD increases, though, symptoms tend to get more severe and present earlier on in life.
A left-sided S3 is best heard in the left lateral decubitus position and at the apex of the heart, which is normally located in the 5th left intercostal space at the midclavicular line. A right-sided S3 is best heard at the lower left sternal border.
Systolic murmur of tricuspid regurgitation = Holosystolic or early systolic murmur along the lower left sternal border depending on the severity of the regurgitation; Right atrial hypertrophy; Right ventricular conduction defects; Wolff-Parkinson-White syndrome often accompanies
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Auscultatory findings include inspiratory third heart sound at left lower sternal border (LLSB) [16] and a blowing holosystolic murmur at LLSB, intensifying with inspiration, and decreasing with expiration and Valsalva maneuver. [16] Patients may have a parasternal heave along LLSB. [16]
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