Still's murmur

Still's murmur (also known as vibratory murmur) is a common type of benign or "innocent" functional heart murmur that is not associated with any sort of cardiac disorder or any other medical condition. It can occur at any age although it is most common among children two to seven years of age and it is rare in adulthood.

Still’s murmur was initially described by Dr. George Frederic Still, England’s first professor of childhood medicine at the Great Ormond Street Hospital for Children. In his pediatric textbook Common Disorders and Diseases of Childhood (published 1909) Dr. Still noted:

“I should like to draw attention to a particular bruit which has somewhat of a musical character, but is neither of sinister omen nor does it indicate endocarditis of any sort. …its characteristic feature is a twangy sound, very like that made by twanging a piece of tense string... Whenever may be its origin, I think it is clearly functional, that is to say, not due to any organic disease of the heart either congenital or acquired.”

Still's murmur is detected via auscultation with a stethoscope. It has a peculiar "musical", "resonant" or "vibratory" quality that is quite unique. It is generally most easily heard at the left middle or lower sternal border and the right upper sternal border, often with radiation to the carotid arteries, although other locations are common. The murmur is usually louder in the supine position and may only be audible in the supine position.

The Still’s murmur can be differentiated from pathological murmurs by this musical quality and lack of extra snaps or clicks in the heart sounds.

Because the Still's murmur has never been associated with any sort of cardiac disorder, it has no associated symptoms.

Heart murmurs are sounds generated by blood flowing through the structures of the heart. The location of the Still's murmur on examination suggests resonation of blood in the left ventricular outflow tract and aorta, and this is supported by studies that have shown that the murmur is more intense over the aortic valve than the pulmonary valve. There has been conjecture that the vibratory or musical quality of the murmur is caused by vibration of “false chordae” of the left ventricle, which are a common finding in normal individuals, but no relationship between the two has been proven. There is some evidence that a smaller aorta with higher peak flow velocities are associated with Still’s murmur, which certainly fits in well with the concept that the murmur is a musical phenomenon.

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Wikipedia