Synonyms: Fiddle string murmur, Vibratory murmur

First described by Sir George Still (1868-1941) the first Professor of Paediatrics in the United Kingdom.¹

Epidemiology

It is most common in children ages 2 to 8 years old.

Presentation

It is a short, early systolic murmur with a vibratory quality, of maximal intensity at the lower left sternal edge or apex and which changes with posture.²
It is provoked by:

• The supine position
• Fever
• Anaemia

The murmur is not associated with any underlying pathological cardiac condition.
ECG and cardiac echo are normal and the murmur usually disappears at puberty.

Differential diagnosis

• Ventricular septal defect
• Left ventricular outflow obstruction
• Hypertrophic cardiomyopathy