Fig. 23.1
Still’s murmurs are generally Grade 1–3 early systolic murmurs heard best by placing the bell of the stethoscope between the lower left sternal border and the apex of the heart. They have been described as vibratory or musical in quality with a low to medium pitch. They can be heard loudest when the child is supine and will decrease in intensity when the child stands. Still’s murmurs are most commonly heard in children under the age of 7 and are benign findings
This murmur is diagnosed as a Still’s murmur (innocent murmur) [1]. No further testing is ordered.
Clinical Basics
Begin by Obtaining a Good History and Physical
Historical Clues
Exclude that there is a family history of cardiac congenital anomalies because individuals with an affected relative are more likely to have congenital heart disease [2].
Exclude any abnormalities in the birth and prenatal hx [3].
Examples:
Intrauterine insult.
Low birth weight.
Postnatal poor feeding.
Maternal diabetes mellitus.
General Examination
Dysmorphic features should be identified, as should any abnormalities within the general cardiovascular examination.
Examples:
Down’s syndrome.
Tachycardic at rest.
Weak femoral pulse.
Full pulses.
Precordial bulge of chest wall.
Key Auscultation Features
Focus on each sound individually initially.
Innocent murmurs arise from turbulent ejection, and tend to be short in duration, low in intensity and poorly transmitted across the precordium.
Specific auscultation features:
Low frequency.
Early systolic ejection murmur, crescendo-decrescendo.
Best heard at left lower sternal border extending to the cardiac apex. See Fig. 23.1.
Usually noted after infancy and has peak incidence in 3–7 year olds.
Displays vibratory or buzzing quality.
Vary with positioning, and best appreciated with bell of stethoscope while patient is supine.
Intensity reduced by Valsalva maneuver.
Features of murmurs associated with cardiac abnormalities.
Unusually loud murmurs.
Diastolic or pansystolic, or late systolic murmurs.
Associated with any other cardiac abnormality.
Adults may also have benign systolic ejection murmurs.
Characteristics.
Occurs mostly in adults over 50 years old; relatively common.< div class='tao-gold-member'>Only gold members can continue reading. Log In or Register to continue
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