PEARL Oct 2nd

What are the features of innocent vs pathologic heart murmurs in children?  What are the following murmurs, and what are their causes: Still’s murmur, physiologic systolic ejection murmur, supraclavicular arterial bruit, neonatal peripheral stenosis, cervical venous hum, and mammary soufflé?


Features of innocent heart murmurs:


>50% of children have benign murmurs.  They are due to turbulent flow at the origin of the great vessels.  They are better heard in children than adults because:


–Thin chest wall in children

–More angulated great vessels in children

–More dynamic circulation in children


Types of innocent murmurs:

Still’s murmur:

Due to blood flow across aortic valve.  Heard best over RUSB and is a systolic ejection murmur (vibratory and musical in quality).  It is seen in infancy to adolescence.


Physiologic systolic ejection murmur:

Second most common.  Heard best at mid to upper sternal border.  Heard best with diaphragm due to frequency.


Supraclavicular arterial bruit:

Above and NOT below the clavicle.  Louder on the right due to brachiocephalic arteries branching.


Neonatal peripheral pulmonary stenosis (PPS):

Birth to 3-6 months.  Heard best at base, both axillae, and back.  Due to relative small size of branch pulmonary arteries and angle of bifurcation of the PAs.


Cervical venous hum:

Continuous hum.  Heard over RUSB.  Better in sitting, disappears in supine position and when pressure is applied to neck to reduce venous blood return


Mammary soufflé:

Noted in lactating mothers, due to increased mammary blood flow.




– All diastolic murmurs

– All pansystolic murmurs

– Late systolic murmurs

– Loud murmurs (>3/6)

– Continuous murmurs

– Associated cardiac abnormalities



– How to distinguish between innocent and pathologic heart murmurs in children.  Rosenthal, A.  The pediatric clinics of North America, Dec 1984, page 129

– Innocent murmurs.  Newburger, JW.  Pediatric Cardiology, page 281