Document Detail

Genesis of Still's murmurs: a controlled Doppler echocardiographic study.
MedLine Citation:
PMID:  1931348     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The origin of innocent systolic murmurs is uncertain. This study was designed to evaluate the relative contribution in the same subjects of the main factors implicated in the genesis of vibratory innocent systolic murmurs--that is, the presence of left ventricular bands and increased left ventricular flow indices--and to examine evidence for turbulence in relation to these findings. PATIENTS: 40 children with innocent systolic murmurs and 40 paired controls without murmurs were matched for age and body surface area. DESIGN: These subjects were examined prospectively by cross sectional echocardiography with pulsed and continuous wave Doppler and colour flow mapping. SETTING: A tertiary referral centre for paediatric cardiology. RESULTS: Left ventricular bands were significantly more prevalent in patients with innocent murmurs (70%) than in controls (48%) but only if apical bands were included (p = 0.039). Cases had significantly higher aortic peak flow velocities (p less than 0.001), flow integrals (p = 0.001), and stroke volumes (p = 0.014), and significantly lower heart rates (p = 0.033) than controls. There were no significant differences between cases and controls in mean aortic diameter, cardiac output, or ejection fraction. There was no evidence of turbulence in the left ventricle or outflow tract in any individual but curvilinear periodic vibrations and audible "whoops" were detected in the left ventricle by pulsed wave Doppler echocardiography. These were significantly more common in cases than controls (p less than 0.01) but were not related to the presence of bands. CONCLUSIONS: Innocent systolic murmurs were unrelated to aortic size but they were strongly associated with higher aortic flow volume and velocity, with relative bradycardia, and with evidence of vibratory phenomena in the left ventricle. The role of left ventricular bands remains uncertain.
H M Gardiner; H S Joffe
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  British heart journal     Volume:  66     ISSN:  0007-0769     ISO Abbreviation:  Br Heart J     Publication Date:  1991 Sep 
Date Detail:
Created Date:  1991-12-10     Completed Date:  1991-12-10     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0370634     Medline TA:  Br Heart J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  217-20     Citation Subset:  AIM; IM    
Royal Hospital for Sick Children, Bristol.
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MeSH Terms
Child, Preschool
Echocardiography, Doppler*
Heart Murmurs / etiology,  physiopathology,  ultrasonography*
Heart Ventricles / physiopathology,  ultrasonography
Prospective Studies
Systole / physiology
Comment In:
Br Heart J. 1992 Feb;67(2):206   [PMID:  1540448 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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