Patient Information

Still's Murmur

People often worry when they hear that their child has a heart murmur.  Happily, most heart murmurs in children are perfectly normal.  One such murmur is the “Still’s murmur”.

History 
The Still’s murmur was initially described by Dr. George Frederic Still, England’s first professor of childhood medicine.  In his pediatric textbook Common Disorders and Diseases of Childhood published in 1909 Dr. Still noted:

“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.”

What Causes It? 
In fact, no one knows exactly what causes a Still’s murmur.  People have looked very closely using ultrasound at the hearts of children with this murmur, and compared them to the hearts of children who do not.  No difference has ever been identified except that the speed of blood traveling through the aorta (the main artery to the body) is a little faster than average.  It is very clear however, that the Still’s murmur is not caused by any type of heart defect.  Having listened to thousands of children this murmur, my personal opinion is that young children have very healthy, elastic hearts that “ring” when they beat, in very much the same way that a soda bottle makes a musical sound when you blow over the top.  Indeed, I suspect the Still’s murmur is a sign of health, given how generally healthy the children are who have it.

Who has them? 
The Still’s murmur may occur in as many as one third of all children between two and five years of age.  It can, however, be heard in children ranging in age from newborns to young adults. Commonly, a Still’s murmur will come and go over time. 

What does it mean? 
It is very important to understand that the Still’s murmur is perfectly normal.  It does not suggest any type of heart disorder.  Children with a Still’s murmur can play sports just like any other normal child, and do not require special medical treatment when they go to the dentist or have other medical procedures.  In fact, it is perfectly fine not to mention this murmur when one is filling out forms for insurance companies, school sports clearance, and dental visits.  Finally, it is not generally necessary for a child with a Still’s murmur to have additional visits with a cardiologist unless they are under a year of age, in which case one additional visit is sometimes recommended just because a lot of changes take place in a child’s heart over the first year of life.

What do I tell the grandparents?
An accurate description of a Still’s murmur is to say that your child has a “musical heart”.

Web Links 
Here are some Internet links that might be helpful.  They look pretty good, but I cannot vouch for their accuracy or quality.  As always with the Internet, browser beware!

Wikipedia: Still's Murmur

George Frederick Still (1868-1941)