Genesis of Still's Murmurs: a Controlled Doppler Echocardiographic Study

Overview

Journal Br Heart J

Specialty Cardiology & Vascular Diseases

Date 1991 Sep 1

PMID 1931348

Citations 6

Authors

H M Gardiner

H S JOFFE

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

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Epidemiology of left ventricular false tendons: clinical correlates in the Framingham Heart Study.

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Echocardiographic study on the origin of the innocent flow murmurs.

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The vibratory innocent heart murmur in schoolchildren: a case-control Doppler echocardiographic study.

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References

McLaren M, Lachman A, POCOCK W, BARLOW J . Innocent murmurs and third heart sounds in Black schoolchildren. Br Heart J. 1980; 43(1):67-73. PMC: 482243. DOI: 10.1136/hrt.43.1.67. View

Hudson I, Houston A, Aitchison T, Holland B, Turner T . Reproducibility of measurements of cardiac output in newborn infants by Doppler ultrasound. Arch Dis Child. 1990; 65(1 Spec No):15-9. PMC: 1590175. DOI: 10.1136/adc.65.1_spec_no.15. View

Nishimura T, Kondo M, Shimada T, Shimono Y, Mukohyama N . [Echocardiographic features of false tendons: with special reference to phonocardiographic significance (author's transl)]. J Cardiogr. 1981; 11(1):253-63. View

Stein P, Sabbah H, Magilligan Jr D, Lakier J . Mechanism of a musical systolic murmur caused by a degenerated porcine bioprosthetic valve. Am J Cardiol. 1982; 49(8):1874-82. DOI: 10.1016/0002-9149(82)90205-3. View

Goldberg S, Sahn D, ALLEN H, Hoenecke H, Carnahan Y . Evaluation of pulmonary and systemic blood flow by 2-dimensional Doppler echocardiography using fast Fourier transform spectral analysis. Am J Cardiol. 1982; 50(6):1394-400. DOI: 10.1016/0002-9149(82)90481-7. View

Chandraratna P, Nanna M, Mckay C, Nimalasuriya A, Swinney R, Elkayam U . Determination of cardiac output by transcutaneous continuous-wave ultrasonic Doppler computer. Am J Cardiol. 1984; 53(1):234-7. DOI: 10.1016/0002-9149(84)90718-5. View

Brenner J, Baker K, Ringel R, Berman M . Echocardiographic evidence of left ventricular bands in infants and children. J Am Coll Cardiol. 1984; 3(6):1515-20. DOI: 10.1016/s0735-1097(84)80291-0. View

Loeber C, Goldberg S, ALLEN H . Doppler echocardiographic comparison of flows distal to the four cardiac valves. J Am Coll Cardiol. 1984; 4(2):268-72. DOI: 10.1016/s0735-1097(84)80212-0. View

Sheikh M, Lee W, Mills R, Dais K . Musical murmurs: clinical implications, long-term prognosis, and echo-phonocardiographic features. Am Heart J. 1984; 108(2):377-86. DOI: 10.1016/0002-8703(84)90629-x. View

10.

Keren A, Billingham M, Popp R . Echocardiographic recognition and implications of ventricular hypertrophic trabeculations and aberrant bands. Circulation. 1984; 70(5):836-42. DOI: 10.1161/01.cir.70.5.836. View

11.

Dickinson D, Goldberg S, Wilson N . A comparison of information obtained by ultrasound examination and cardiac catheterisation in paediatric patients with congenital heart disease. Int J Cardiol. 1985; 9(3):275-88. DOI: 10.1016/0167-5273(85)90025-7. View

12.

Schwartz M, Goldberg S, Wilson N, ALLEN H, Marx G . Relation of Still's murmur, small aortic diameter and high aortic velocity. Am J Cardiol. 1986; 57(15):1344-8. DOI: 10.1016/0002-9149(86)90216-x. View

13.

Marx G, Goldberg S, ALLEN H . Two methods for measurement of ascending aortic diameter by 2D echocardiography as compared with cineangiography. Am Heart J. 1986; 112(1):172-3. DOI: 10.1016/0002-8703(86)90698-8. View

14.

Boyd M, Seward J, Tajik A, Edwards W . Frequency and location of prominent left ventricular trabeculations at autopsy in 474 normal human hearts: implications for evaluation of mural thrombi by two-dimensional echocardiography. J Am Coll Cardiol. 1987; 9(2):323-6. DOI: 10.1016/s0735-1097(87)80383-2. View

15.

Sholler G, Celermajer J, Whight C . Doppler echocardiographic assessment of cardiac output in normal children with and without innocent precordial murmurs. Am J Cardiol. 1987; 59(5):487-8. DOI: 10.1016/0002-9149(87)90966-0. View

16.

van Oort A, van Dam I, Heringa A, Alsters J, Hopman J, Daniels O . The vibratory innocent heart murmur studied by echo-Doppler. Acta Paediatr Scand Suppl. 1986; 329:103-7. DOI: 10.1111/j.1651-2227.1986.tb10394.x. View

17.

Darazs B, Hesdorffer C, Butterworth A, ZIADY F . The possible etiology of the vibratory systolic murmur. Clin Cardiol. 1987; 10(5):341-6. DOI: 10.1002/clc.4960100509. View

18.

. British Paediatric Association, annual general meeting. York, 7-10 April 1987. Abstracts. Arch Dis Child. 1987; 62(6):645-52. PMC: 1778444. DOI: 10.1136/adc.62.6.645. View

19.

Pennestri F, Boccardi L, Minardi G, Di Segni M, Pucci E, Biasucci L . Doppler study of precordial musical murmurs. Am J Cardiol. 1989; 63(18):1390-4. DOI: 10.1016/0002-9149(89)91054-0. View