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Still's Murmur

Am J Dis Child. 1988;142(4):416. doi:10.1001/archpedi.1988.02150040066015.
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Sir.—I enjoyed reading Dr McNamara's scholarly editorial "The Pediatrician and the Innocent Heart Murmur."1 As usual, Dr McNamara made a lucid presentation of a rather complex subject.

Among his descriptions of the four common functional heart murmurs, that of the Still's murmur deserves additional comment. Dr McNamara correctly characterized Still's murmur as an aortic vibratory murmur. Although Still's murmur was originally thought to be due to trigonoidation of the pulmonic valve cusps in systole,2 more recent work has shown that it originates from the aortic or subaortic region.3 Although Dr McNamara appropriately called Still's murmur an aortic murmur—a concept not too familiar to adult cardiologists—he forgot to point out that it is usually heard along the left sternal border instead of the so-called aortic area in the right second intercostal space.4


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