Still's Murmur Characteristics and Clinical Significance

Characteristics of Still's Murmur

• Still's murmur is classified as an innocent murmur, meaning it is not associated with any structural cardiac defects 1, 2
• It has a medium pitched, vibratory quality that is distinctive in its sound 3, 4
• The murmur is typically heard at multiple locations including the apex of the heart 1, left lower sternal border 3, left middle sternal border 5, and right upper sternal border 1, 3, 5
• When the patient assumes an upright position, the murmur either disappears completely 6, or becomes quieter and localizes specifically to the left lower sternal border 1, 3

Clinical Significance

• Unlike pathologic murmurs, Still's murmur does not indicate underlying structural heart disease 1

Differentiation from Pathologic Murmurs

• Still's murmur can be distinguished from pathologic murmurs by its vibratory quality (rather than harsh) 1, 3, its response to positional changes (quieter when standing) 1, 5, and its medium pitch 3, 6