Still’s murmur

Description

Still’s Murmur is an innocent physiologic murmur that usually occurs in your children.

The murmur is soft with a musical or vibratory quality sometimes described as “twangy” (like a string being plucked). It is a crescendo-decrescendo medium-to-long ejection systolic murmur, heard loudest at the left lower sternal border and apex, and best heard with bell of stethoscope.

The murmur increases in intensity with high output states, such as fever, anxiety, and exercise. The cause of Still’s murmur is not well understood. It is thought to be due to the resonance of blood ejected into the aorta, or to the vibration of the chordae tendineae.

History of the Still murmur

1909 – George Frederic Still first described the murmur in his book ‘Common disorders and diseases of childhood’:

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 GF. 1909 434-435

1980s – Several authors postulated about left ventricular bands and false chordae tendineae as the cause of Still’s murmur, but the aetiology remains not well understood

1986 – Schwartz et al. provided pulsed Doppler and 2-dimensional echocardiogram evidence for the association between high aortic velocity and Still’s murmur

1991 – Klewar et al. produced Still’s murmur in subjects without murmurs at rest using dobutamine stress echocardiography to increase aortic velocity

Associated persons

• George Frederic Still (1868-1941)

Alternative names

• Innocent vibratory murmur
• Vibratory murmur
• Musical murmur
• Functional murmur

References

Original articles

• Still GF. Common disorders and diseases of childhood. London: Henry Frowde and Hodder and Stoughton. 1909. [Still’s murmur 434-435, 481.]

Review articles

• Darazs B et al. The possible etiology of the vibratory systolic murmur. Clin Cardiol. 1987; 10(5): 341-346
• Perry LW et al. Left ventricular false tendons in children: prevalence as detected by 2-dimensional echocardiography and clinical significance. Am J Cardiol. 1983; 52(10): 1264-6.
• Schwartz ML et al. Relation of Still’s murmur, small aortic diameter and high aortic velocity. Am J Cardiol. 1986; 57(15): 1344-8.
• Klewer SE, Donnerstein RL, Goldberg SJ. Still’s-like innocent murmur can be produced by increasing aortic velocity to a threshold value. Am J Cardiol. 1991; 68(8): 810-812.
• Gardiner HM, Joffe HS. Genesis of Still’s murmurs: a controlled Doppler echocardiographic study. British Heart Journal. 1991;66(3):217-220
• Robbins A, Zhang G, Cadogan M. Name that murmur. LITFL 2022
• Cadogan M. Still’s murmur. Eponym A Day. Instagram

[cite]