Still's murmur, also known as a "vibratory" or "innocent" murmur, is a common and benign heart murmur often heard in children, including neonates. It is named after Dr. George Frederic Still, who first described the condition. This type of murmur is usually a result of normal blood flow through the heart and does not indicate any underlying heart disease.
Still's murmur is typically detected during a routine physical examination when a healthcare provider listens to the heart using a stethoscope. The murmur has a characteristic "musical" or "vibratory" quality and is usually heard best at the lower left sternal border of the chest. It is more prominent when the child is lying down and may diminish or disappear when the child stands up.
The exact cause of Still's murmur is not completely understood. However, it is thought to be related to the vibrations caused by blood flowing through the heart or the great vessels. Factors such as the thin chest wall in infants and young children, increased blood flow, and the proximity of the heart to the chest wall may contribute to the audibility of the murmur.
No, Still's murmur is not harmful. It is considered an innocent murmur, meaning it is not associated with any structural heart abnormalities or other health issues. Children with Still's murmur are typically healthy and do not experience any symptoms related to the murmur.
Differentiating Still's murmur from pathological murmurs is crucial. Pediatricians use several criteria to distinguish between innocent and potentially harmful murmurs:
1. Sound Quality: Still's murmur has a musical or vibratory quality, while pathological murmurs may sound harsh or blowing.
2. Location and Timing: Still's murmur is usually heard best at the lower left sternal border and occurs during systole. Pathological murmurs may be heard in different locations and may occur during diastole.
3. Intensity: Innocent murmurs are typically low in intensity and do not radiate widely. Pathological murmurs may be louder and radiate to other parts of the chest or back.
4. Response to Position Changes: Innocent murmurs may change or disappear with changes in body position, while pathological murmurs are usually unaffected by position.
If a healthcare provider suspects Still's murmur, they may perform a thorough physical examination and review the child's medical history. In most cases, no further testing is needed. However, if there is any doubt about the nature of the murmur or if the child has other symptoms (such as poor growth, difficulty breathing, or cyanosis), additional tests such as an echocardiogram may be ordered to rule out structural heart disease.
Yes, children typically outgrow Still's murmur. The murmur often becomes less audible as the child grows older and the chest wall thickens. By adolescence, the murmur usually disappears entirely.
Children with Still's murmur do not require any special restrictions or lifestyle changes. They can participate in all normal activities, including sports and physical exercise, without any concerns related to the murmur. Regular follow-up with a healthcare provider is usually not necessary unless new symptoms develop.
Conclusion
Still's murmur is a common and benign condition in neonates and young children. It is important for healthcare providers to recognize the characteristics of this innocent murmur to avoid unnecessary tests and anxiety for the family. Understanding that Still's murmur is a normal variant of heart sounds can provide reassurance and allow children to lead healthy, active lives without restrictions.
