Which statement best describes Still's murmur?

Which statement best describes Still's murmur?

• A. Pathologic murmur
• B. Still's murmur
• C. Pulmonary flow murmur
• D. Venous hum

Answer: (B)

Think of Still's murmur as a common harmless heart sound in children. It is a soft, midsystolic, vibratory or musical murmur heard best at the left lower sternal border (often also noted near the apex) in kids around ages 2 to 7. There are no signs of heart disease: the second heart sound is normal, there are no symptoms, and there’s no radiation or thrills. This murmur is typically louder when the child is lying down or quiet and tends to fade or disappear with standing or sitting up. These features—benign quality, pediatric timing and location, normal exam findings, and behavior with position—make it the best description of Still’s murmur. Other murmurs described in the choices point to different entities: a pathologic murmur implies disease; a pulmonary flow murmur has a different location (left upper sternal border) and sometimes different triggers; a venous hum is a continuous murmur arising from jugular flow.

Think of Still's murmur as a common harmless heart sound in children. It is a soft, midsystolic, vibratory or musical murmur heard best at the left lower sternal border (often also noted near the apex) in kids around ages 2 to 7. There are no signs of heart disease: the second heart sound is normal, there are no symptoms, and there’s no radiation or thrills. This murmur is typically louder when the child is lying down or quiet and tends to fade or disappear with standing or sitting up. These features—benign quality, pediatric timing and location, normal exam findings, and behavior with position—make it the best description of Still’s murmur. Other murmurs described in the choices point to different entities: a pathologic murmur implies disease; a pulmonary flow murmur has a different location (left upper sternal border) and sometimes different triggers; a venous hum is a continuous murmur arising from jugular flow.