A 7 year old boy presents for a camp physical. The following is found:-Systolic ejection murmur with a vibratory character-The murmur is heard best in lower precordium and not in the back-The murmur decreases with positional changes that decrease venous return.What is the most likely murmur?
Still’s murmurStill’s murmur is very common in childhood. It usually has a musical quality, and some say it sounds like a plucked-string instrument or a kazoo. It is the most common innocent murmur in children beyond the newborn period.
Based on the information given, the most likely murmur is a Still’s murmur. Still’s murmur is a benign, innocent heart murmur that is common in children, especially between the ages of 3 and 7 years. It is typically described as a systolic ejection murmur with a vibratory or musical quality that is heard loudest at the lower left sternal border. The murmur is typically heard best when the child is lying down and decreases or disappears when the child is sitting up or standing.
A characteristic feature of Still’s murmur is that it decreases with positional changes that decrease venous return. This is because the murmur is thought to be caused by vibrations in the left ventricular outflow tract, and changes in venous return can alter the flow dynamics in this area, affecting the intensity of the murmur. Still’s murmur is generally considered to be harmless and does not require any treatment or follow-up, although some children may require further evaluation if the murmur is particularly loud or has other associated symptoms.
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