II. History

  1. First described by Dr. George Still (1909)

III. Epidemiology

  1. Common in children ages 2 to 8 years old (peaks age 3 to 6 years)

IV. Physiology

  1. Unknown cause
  2. May be due to the sound of Blood Flowing into aorta, or across the chodae tendinae

V. Signs

  1. Low to medium frequency, mid-Systolic Murmur
  2. Intensity: Grade 1-3 of 6 (variable)
  3. Location: near apex to lower left sternal border
  4. Character
    1. Low to medium pitch
    2. Vibratory, harmonic, musical, twanging, groaning
  5. Provocative conditions and positions (increased murmur)
    1. Supine position (decreased with standing)
    2. Fever
    3. Anemia

VI. Differential Diagnosis

  1. Ventricular Septal Defect
  2. Left ventricular outflow obstruction
  3. Hypertrophic Cardiomyopathy

VII. Course

VIII. Resources

  1. Still's Murmur (USMLE Clinic, YouTube)
    1. https://www.youtube.com/watch?v=_fKtN7orsxg

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