Still’s Murmur

What is Still’s murmur?

Still’s murmur is a heart murmur not related to a heart problem or other medical condition (innocent heart murmur). It is mainly found in young children. Blood flowing through the heart creates the murmur.

Still’s murmur makes a musical, low-pitched vibration. Lying on your back facing upward (supine) often produces the loudest murmur. Healthcare providers can hear the murmur by using a stethoscope placed low on your child’s chest.

Though many children have Still’s murmur, it often goes away by adulthood. Providers don’t treat Still’s murmur. The condition poses no danger to your child’s health.

Who might have Still’s murmur?

Anyone at any age can have Still’s murmur. Most people have it between ages 3 and 6. Still’s murmur usually goes away completely by adolescence.

How common is Still’s murmur?

Up to 72% of children have a heart murmur at some point. Still’s murmur is the most common innocent heart murmur in children.

What causes Still’s murmur?

Blood flowing through your child’s heart creates the sounds of Still’s murmur, but providers don’t know the exact cause of this murmur. Possible causes suggested by researchers include:

• Fibrous bands (false tendons) in the left ventricle, which may produce a vibrating noise with blood flow.
• Increased turbulence of blood flow through the heart that can be related to anemia (low red blood cell count).
• Thin, strong chords (chordae) connected to the tricuspid valve inserted into blood flow from the right ventricle (lower right chamber of the heart).
• Vibrations created by blood flowing through the heart chambers.

What are the symptoms of Still’s murmur?

The main symptom of Still’s murmur is a soft vibration. This can sound musical like an Aeolian harp, which is a string instrument played by the wind. You probably can’t hear your child’s murmur, but your provider can hear it with a stethoscope.

Still’s murmur tends to be louder when your child lies down with their face up and softer when they sit or stand up. The murmur can come and go at different times. Still’s murmur can be louder when children are sick or excited.

Still’s murmur doesn’t cause other medical symptoms or health issues.

How is Still’s murmur diagnosed?

Your healthcare provider will first ask about your child’s medical history and do a physical exam. The physical exam will include checking your child’s:

• Abdomen (abdominal palpation) to check for an enlarged liver and heart failure.
• Blood pressure.
• Chest wall (chest palpation) to check for an enlarged heart (cardiomegaly).
• Oxygen levels with pulse oximetry.
• Pulses in your child’s feet (distal pulse palpation) to check blood flow.

Your provider will also listen to the internal sounds of your child’s body by using a stethoscope. They will listen for:

• Abnormal sounds.
• Clicks.
• Murmurs.

If your provider hears a heart murmur, they will monitor:

• Whether the murmur changes with movement. Lying down produces a louder sound with Still’s murmur.
• If the murmur happens when the heart contracts (systolic murmur), when the heart rests (diastolic murmur) or all the time. Still’s murmur is mid-systolic, meaning it happens after the heart contracts.
• Whether they can hear the murmur in only one place or in many (radiation). Still’s murmur has no radiation.
• Location of the murmur. Still’s murmur comes mainly from the lower-left area of the sternum (in the center of your chest and at the front of your rib cage).
• Loudness or softness of the murmur (intensity). Still’s murmur produces a soft sound.
• The sound (quality) of the murmur and pitch (low, medium or high). Still’s murmur has a musical, blowing sound and low pitch.

If your provider diagnoses Still’s murmur, your child doesn’t need any other tests. If your provider suspects a non-innocent heart murmur, or is unsure if what they are hearing is a Still’s murmur, they may refer your child to a cardiologist for further testing, which can include:

• Electrocardiogram (EKG), which records the heart’s electrical activity.
• Echocardiogram (echo), where high-frequency sound waves create pictures of the heart’s chambers and valves.

How is Still’s murmur treated?

Your child doesn’t need any treatment for Still’s murmur. It usually goes away over time.

How do I take care of myself or my child with Still’s murmur?

Your child can live a normal life with Still’s murmur. They can continue to exercise, go to school and do their day-to-day activities.

How can I reduce my child’s risk of Still’s murmur?

You can’t reduce your child’s risk of Still’s murmur.

What can I expect if my child has Still’s murmur?

Still’s murmur usually goes away before adulthood. Some adults may still have a murmur, but never show any symptoms.

What is the outlook if my child has Still’s murmur?

Still’s murmur is not a sign of heart disease or any other health condition. People with Still’s murmur can lead full, active lives. They can play sports, go to school and participate in all activities.

How do I take care of my child’s Still’s murmur?

If your child has Still’s murmur, continue to see their healthcare provider for regular physical exams. They can help monitor your child’s overall health.

When should my child see their healthcare provider?

See your child’s provider if they have any new symptoms. Seek medical treatment immediately if they have:

• Chest pain, discomfort or tightness in the chest.
• Extreme fatigue.
• Fainting.
• Shortness of breath (dyspnea) or difficulty breathing.

A note from Cleveland Clinic

Still’s murmur is a common heart murmur not related to any health condition. Children between ages 3 and 6 most commonly have this murmur. Still’s murmur usually goes away by adolescence. Providers don’t know the cause of Still’s murmur. They diagnose the murmur with a physical exam and use a stethoscope to listen to your body’s sounds. Though this type of murmur may seem like cause for concern, Still’s murmur doesn’t lead to any other health issues. You can lead an active life with this condition.