Still's Murmur

By Joanna Kmiecik, MD, MS, MPH, MBA - Posted in Clinical Education
Learn about the most common benign murmur that affects 1 in 3 children.
Pencil drawing of the anatomy of the heart and blood flow to and from the lungs and body

Overview

Still's murmur is the most common benign murmur, impacting 1 in 3 children. It occurs in the pediatric population and is typically discovered between 2 and 7 years of age. The most common age of a patient with Still's murmur is 3 years. There's no correlation with patients' gender. There are no medical consequences of not treating Still's murmur; it resolves on its own by adolescence and it does not carry any unwanted medical consequences.

 

Pathophysiology

There is no clear explanation of the pathophysiology of Still's murmur. It's believed that it's caused by rapid blood flow via the normal aortic valve by increased cardiac output or increased contractility of the heart muscle. There are also other theories of the mechanisms of creating the murmur including the potential presence of fibrous bands or false tendons in the left ventricle, which can cause a vibration of the blood. Also, the presence of a smaller aortic root size, which becomes a partial obstruction for blood to move via the aortic valve, can form Still's murmur. With so many speculations there is still no clear agreement on how the murmur is being formed.

 

Visual representation of a Still's murmur recording

 

Audio

Still’s murmur is a brief, low-pitched, vibratory, 1-3 midsystolic crescendo-decrescendo murmur without snaps or clicks. The sound of the murmur does not worsen or change with time and the child’s growth. Still’s murmur is best heard at the left lower sternal border with the possibility of radiation to the apex. It's loudest in the supine position and best heard with the bell of the stethoscope.

 

Visual representation of a Still's murmur recording

 

ECG

There are no specific changes on the ECG for Still's murmur.

 

Actual recording

This sound was recorded using a stethoscope powered by Eko technology.

 

References

1. Doshi A. R. (2018). Innocent Heart Murmur. Cureus, 10(12), e3689. https://doi.org/10.7759/cureus.3689

2. Hay, W., 2009. Current Pediatric Diagnosis & Treatment. New York: McGraw-Hill Medical.

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About the Author

Joanna Kmiecik, MD, MS, MPH, MBA
Joanna Kmiecik, MD, MS, MPH, MBA - Family Medicine Specialist

Joanna Kmiecik, MD, MS, MPH, MBA, is a board-certified physician in Family Medicine, Obesity Medicine, and Lifestyle Medicine. She completed her medical school at Jagiellonian University in Cracow and residency training at Swedish Covenant Hospital in Chicago. She has experience working in clinical settings such as emergency, inpatient, and outpatient; she is actively practicing medicine in Chicago. She holds six master's degrees, including a Master in Health Informatics, Master in Public Health, Master in Patient Safety Leadership from the University of Illinois at Chicago; Master in Bioethics and Health Policy from the University of Loyola in Chicago, Master in Exercising Science from the University of PennWest Pennsylvania, and Master in Business Administration from the University of Cumbria. She has been teaching students and residents at several universities and residency training programs. Dr. Kmiecik’s interests are in preventive medicine, information technology, and women's health.