121:
112:. 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.
61:“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.”
77:. 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
173:
However, families are often anxious when told their child has a heart murmur. Parents of children diagnosed with Still's murmur may experience significantly greater anxiety than the children themselves. In a study conducted on the families impacted by Still's murmur, the parents were worried about a
144:
may be helpful in ruling out other conditions, particularly if the physical examination is not completely characteristic of Still's murmur. When additional testing is done in the setting of Still's murmur the results are normal, since Still's murmur is not associated with any sort of cardiovascular
161:
Still's murmurs may occur in as many as a third of all children. This type of murmur occurs most often in children two to seven years of age, but can occur in younger or older children. In most cases, the innocent Still's murmur is present on and off during childhood and resolves on its own by
178:(29%), other offspring also having Still's murmur (20%), and early death (13%). Mothers worried that they did something during pregnancy that caused the murmur (19%). Even after being reassured by the child's physician, 17% of parents were still anxious. After hearing from a
20:
22:
99:
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
45:
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.
569:
21:
170:
The Still's murmur is a harmless finding that does not suggest any medical disorder. In most cases, Still's murmur disappears around adolescence without medical intervention.
517:
Geggel RL, Horowitz LM, Brown EA, et al. (2002). "Parental anxiety associated with referral of a child to a pediatric cardiologist for evaluation of a Still's murmur".
562:
389:
Klewer, S.E.; Donnerstein, R.L.; Goldberg, S.J. (1991). "Still's-like innocent murmur can be produced by increasing aortic velocity to a threshold value".
424:
Schwartz, M.L.; Goldberg, S.J.; Wilson, N.; Allen, H.D.; Marz, G.R. (1986). "Relation of Still's murmur, small aortic diameter and high aortic velocity".
555:
346:
van Oort, A.; van Dam, I.; Heringa, A.; Alsters, J.; Hopman, J.; Daniëls, O. (1986). "The vibratory innocent heart murmur studied by echo-Doppler".
459:
Donnerstein, R.L.; Thomsen, V.S. (1994). "Hemodynamic and anatomic factors affecting the frequency content of Still's innocent murmur".
54:
214:
174:
variety of issues. Their concerns included: the need for medicine (49%), facing sports restrictions (41%), the need for
153:
Still's murmur does not represent any sort of disorder and does not present a health risk, so no treatment is necessary.
91:
Because the Still's murmur has never been associated with any sort of cardiac disorder, it has no associated symptoms.
84:
The Still's murmur can be differentiated from pathological murmurs by this musical quality and lack of extra snaps or
992:
57:. In his pediatric textbook Common Disorders and Diseases of Childhood (published 1909) Dr. Still noted:
1197:
1156:
547:
964:
128:
Still's murmur is diagnosed in the course of a physical examination of the patient, usually using a
720:
820:
682:
1045:
883:
677:
1150:
660:
104:, and this is supported by studies that have shown that the murmur is more intense over the
1176:
1083:
987:
892:
705:
687:
8:
1230:
1203:
1032:
920:
905:
844:
699:
242:
137:
915:
1191:
1186:
1124:
1102:
1096:
910:
867:
711:
694:
643:
582:
578:
371:
359:
324:
120:
983:
857:
852:
775:
665:
638:
534:
499:
476:
472:
441:
437:
406:
402:
363:
328:
293:
257:
210:
132:. The murmur has a vibratory quality that can be detected as a regular frequency on
375:
1088:
1059:
900:
787:
780:
765:
608:
526:
468:
433:
398:
355:
320:
141:
815:
136:, although this type of testing is now rarely used. Additional testing including
1144:
1116:
1077:
1021:
1014:
997:
959:
925:
289:
175:
133:
109:
78:
42:
955:
950:
873:
825:
1224:
1181:
1137:
1110:
735:
648:
598:
530:
182:
that the children would be fine, only 7% of the parents were still nervous.
1026:
945:
803:
655:
628:
620:
538:
423:
261:
105:
50:
480:
445:
410:
367:
974:
936:
862:
760:
755:
725:
577:
129:
85:
74:
332:
283:
832:
590:
311:
Stein, P.D.; Sabbah, H.N. (1977). "Aortic origin of innocent murmurs".
297:
179:
808:
388:
1131:
633:
503:
1068:
1038:
603:
747:
730:
345:
101:
1168:
53:, England's first professor of childhood medicine at the
458:
243:"Evaluation and Management of Heart Murmurs in Children"
275:
124:
Positioning for stethoscope to best hear Still's Murmur
26:
Recording of an innocent Still's murmur in a toddler
516:
73:Still's murmur is detected via auscultation with a
498:. Philadelphia: F.A. Davis Company. p. 169.
310:
1222:
200:
198:
196:
194:
81:and may only be audible in the supine position.
563:
191:
417:
236:
234:
232:
230:
228:
226:
339:
41:) is a common type of benign or "innocent"
570:
556:
285:Common Disorders and Diseases of Childhood
49:Still's murmur was initially described by
487:
304:
288:. London: Hodder and Stoughton. pp.
223:
204:
55:Great Ormond Street Hospital for Children
119:
18:
496:The Theory and Practice of Auscultation
209:. Philadelphia: Elsevier. p. 358.
207:Nadas' Pediatric Cardiology 2nd Edition
1223:
510:
551:
493:
281:
68:
13:
360:10.1111/j.1651-2227.1986.tb10394.x
14:
1242:
282:Still, George Frederick (1909).
240:
156:
452:
382:
1:
325:10.1016/s0002-9149(77)80126-4
185:
473:10.1016/0002-9149(94)90917-2
438:10.1016/0002-9149(86)90216-x
403:10.1016/0002-9149(91)90664-7
165:
148:
115:
7:
1198:superior vena cava syndrome
10:
1247:
1167:
1111:radial artery sufficiency
1067:
1058:
1006:
973:
934:
891:
882:
843:
796:
746:
619:
589:
519:The Journal of Pediatrics
250:American Family Physician
94:
51:Dr. George Frederic Still
721:Pericardial friction rub
241:Frank, Jennifer (2011).
205:Newburger, Jane (2006).
1157:Nicoladoni–Branham sign
821:Jugular venous pressure
683:Pulmonary insufficiency
531:10.1067/mpd.2002.124379
43:functional heart murmur
1046:Gallavardin phenomenon
884:Cardiovascular disease
125:
27:
1151:arteriovenous fistula
965:Bracht–Wachter bodies
123:
88:in the heart sounds.
25:
988:Pericardial effusion
893:Aortic insufficiency
706:Mitral insufficiency
688:Graham Steell murmur
16:Type of heart murmur
921:Austin Flint murmur
700:Carey Coombs murmur
138:electrocardiography
1192:Trendelenburg test
1125:pseudohypertension
1103:Right heart strain
1097:pulmonary embolism
712:Presystolic murmur
583:circulatory system
579:Signs and symptoms
494:Segal, BL (1964).
126:
69:Signs and symptoms
28:
1218:
1217:
1214:
1213:
1177:Friedreich's sign
1084:Cardarelli's sign
1054:
1053:
984:Cardiac tamponade
776:Pulsus bisferiens
666:Functional murmur
432:(15): 1344–1348.
216:978-1-4160-2390-6
162:young adulthood.
134:phonocardiography
23:
1238:
1204:Pemberton's sign
1065:
1064:
1060:Vascular disease
906:De Musset's sign
901:Collapsing pulse
889:
888:
788:Pulsus alternans
781:Pulsus bigeminus
766:Pulsus paradoxus
581:relating to the
572:
565:
558:
549:
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142:echocardiography
140:(ECG or EKG) or
39:vibratory murmur
34:
24:
1246:
1245:
1241:
1240:
1239:
1237:
1236:
1235:
1221:
1220:
1219:
1210:
1187:Kussmaul's sign
1163:
1078:aortic aneurysm
1050:
1022:Anitschkow cell
1015:rheumatic fever
1002:
969:
930:
911:Duroziez's sign
878:
839:
792:
742:
615:
585:
576:
546:
515:
511:
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348:Paediatr. Scand
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280:
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266:
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245:
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224:
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192:
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168:
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110:pulmonary valve
97:
79:supine position
71:
65:
37:(also known as
32:
19:
17:
12:
11:
5:
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1234:
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1041:
1029:
1024:
1019:
1010:
1008:
1004:
1003:
1001:
1000:
995:
979:
977:
971:
970:
968:
967:
962:
956:Janeway lesion
953:
941:
939:
932:
931:
929:
928:
923:
918:
913:
908:
903:
897:
895:
886:
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879:
877:
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874:Template:Shock
870:
865:
860:
855:
849:
847:
841:
840:
838:
837:
835:
830:
829:
828:
826:Cannon A waves
818:
813:
812:
811:
800:
798:
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793:
791:
790:
785:
784:
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723:
718:
717:
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714:
702:
697:
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691:
690:
685:
675:
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671:Still's murmur
668:
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636:
625:
623:
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611:
601:
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586:
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574:
567:
560:
552:
545:
544:
509:
486:
467:(5): 508–510.
461:Am. J. Cardiol
451:
426:Am. J. Cardiol
416:
391:Am. J. Cardiol
381:
338:
319:(5): 665–671.
313:Am. J. Cardiol
303:
274:
256:(7): 793–800.
222:
215:
189:
187:
184:
167:
164:
158:
155:
150:
147:
117:
114:
96:
93:
70:
67:
15:
9:
6:
4:
3:
2:
1243:
1232:
1229:
1228:
1226:
1205:
1202:
1201:
1200:
1199:
1195:
1193:
1190:
1188:
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1183:
1182:Caput medusae
1180:
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1172:
1170:
1166:
1158:
1155:
1154:
1153:
1152:
1148:
1146:
1143:
1139:
1138:Lines of Zahn
1136:
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1133:
1129:
1127:
1126:
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1118:
1115:
1114:
1113:
1112:
1108:
1104:
1101:
1100:
1099:
1098:
1094:
1090:
1089:Oliver's sign
1087:
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1080:
1079:
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1074:
1072:
1070:
1066:
1063:
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1016:
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947:
943:
942:
940:
938:
933:
927:
924:
922:
919:
917:
916:MĂĽller's sign
914:
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909:
907:
904:
902:
899:
898:
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894:
890:
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885:
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869:
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850:
848:
846:
842:
836:
834:
831:
827:
824:
823:
822:
819:
817:
816:CĹ“ur en sabot
814:
810:
807:
806:
805:
802:
801:
799:
795:
789:
786:
782:
779:
777:
774:
773:
772:
769:
767:
764:
762:
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757:
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751:
749:
745:
737:
734:
733:
732:
729:
727:
724:
722:
719:
713:
710:
709:
708:
707:
703:
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698:
696:
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689:
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681:
680:
679:
676:
672:
669:
667:
664:
663:
662:
659:
658:
657:
654:
650:
649:Gallop rhythm
647:
645:
642:
640:
637:
635:
632:
631:
630:
627:
626:
624:
622:
618:
610:
609:Levine's sign
607:
606:
605:
602:
600:
599:Referred pain
597:
596:
594:
592:
588:
584:
580:
573:
568:
566:
561:
559:
554:
553:
550:
540:
536:
532:
528:
525:(6): 747–52.
524:
520:
513:
505:
501:
497:
490:
482:
478:
474:
470:
466:
462:
455:
447:
443:
439:
435:
431:
427:
420:
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408:
404:
400:
396:
392:
385:
377:
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357:
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183:
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177:
176:heart surgery
171:
163:
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146:
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139:
135:
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122:
113:
111:
107:
103:
92:
89:
87:
82:
80:
76:
66:
63:
62:
58:
56:
52:
47:
44:
40:
36:
1196:
1149:
1145:Adson's sign
1130:
1123:
1117:Allen's test
1109:
1095:
1076:
1031:
1027:Aschoff body
1013:
998:Ewart's sign
993:Beck's triad
982:
960:Osler's node
946:endocarditis
944:
926:Mayne's sign
872:See further
868:Distributive
804:Palpitations
770:
704:
670:
656:Heart murmur
629:Heart sounds
621:Auscultation
522:
518:
512:
495:
489:
464:
460:
454:
429:
425:
419:
397:(8): 810–2.
394:
390:
384:
351:
347:
341:
316:
312:
306:
284:
277:
265:. Retrieved
253:
249:
206:
180:cardiologist
172:
169:
160:
157:Epidemiology
152:
127:
106:aortic valve
98:
90:
83:
72:
64:
60:
59:
48:
38:
30:
29:
975:Pericardium
951:Roth's spot
937:endocardium
863:Hypovolemic
858:Obstructive
853:Cardiogenic
761:Bradycardia
756:Tachycardia
726:Heart click
267:14 December
145:pathology.
130:stethoscope
75:stethoscope
1231:Cardiology
833:Hyperaemia
695:Continuous
591:Chest pain
298:B006PCYAWQ
186:References
809:Apex beat
678:Diastolic
354:: 103–7.
166:Prognosis
149:Treatment
116:Diagnosis
108:than the
1225:Category
1132:thrombus
1069:Arterial
661:Systolic
634:Split S2
539:12072881
504:63020195
376:21206205
262:22010618
35:s murmur
771:doubled
736:carotid
481:8059739
446:3717035
411:1892096
368:3473896
1169:Venous
1039:J wave
935:Other
604:Angina
537:
502:
479:
444:
409:
374:
366:
331:
296:
292:–435.
260:
213:
95:Causes
86:clicks
1007:Other
845:Shock
797:Other
748:Pulse
731:Bruit
372:S2CID
333:67794
246:(PDF)
102:aorta
33:'
31:Still
535:PMID
500:LCCN
477:PMID
442:PMID
407:PMID
364:PMID
329:PMID
294:ASIN
269:2020
258:PMID
211:ISBN
1033:EKG
527:doi
523:140
469:doi
434:doi
399:doi
356:doi
352:329
321:doi
290:434
1227::
644:S4
639:S3
533:.
521:.
475:.
465:74
463:.
440:.
430:57
428:.
405:.
395:68
393:.
370:.
362:.
350:.
327:.
317:39
315:.
254:84
252:.
248:.
225:^
193:^
1017::
990::
986:/
958:/
948::
571:e
564:t
557:v
541:.
529::
506:.
483:.
471::
448:.
436::
413:.
401::
378:.
358::
335:.
323::
300:.
271:.
219:.
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
