Still's Murmur

Still's murmur is usually best heard at the lower left sternal border. However, this is not always the case. In some patients, for example, it may be best heard in the right upper sternal border. It may radiate towards the apex and base of the heart and it has a crescendo-decrescendo configuration. The murmur occurs in mid systole. This is in unlike the murmur of VSD, which begins with the first heart sound. The intensity of the murmur is usually 1 or 2 out of 6, occasionally 3, but never louder. Thus it is never associated with a thrill. It is soft with a musical or vibratory quality. It has also been described as being a twangy sound. The murmur is low to medium -pitched and thus best heard with the bell of the stethoscope. If you press the too firmly on the chest wall, however, the functionality of the bell would effectively be changed to that of a diaphragm… in which case the murmur would soften. It is best heard with the patient laying supine and may be more pronounced in patients with a hyperdynamic circulation (e.g., fever, pregnancy). The murmur will soften or even disappear when the patient sits upright or moves to a standing position. Valsalva maneuvers and anything else that decreases preload will also often diminish the murmur.
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Disclaimer: All the information provided by Medical Education for Visual Learners and associated videos are strictly for informational purposes only; it is not intended as a substitute for medical advice from your health care provider or physician. If you think that you or someone that you know may be suffering from a medical condition, then please consult your physician or seek immediate medical attention.

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Audio of the murmur starts at 1 minute

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