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Innocent Murmur — RACP Paediatrics MCQ

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EasyCardiologyInnocent MurmurRACP Paediatrics

A 12-year-old boy is referred with a heart murmur found incidentally during a sports medical. Examination reveals a grade 2/6 ejection systolic murmur at the left sternal edge that varies with position and disappears on standing. There is normal S1 and S2 with no added sounds. ECG is normal. What is the most likely diagnosis?

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Correct answer: B — Innocent flow murmur (Still's murmur)

A vibratory/musical ejection systolic murmur at the left sternal edge that varies with position (decreases on standing) and is low-grade with no associated clicks, thrills or abnormal heart sounds is most consistent with an innocent (Still's) murmur. These murmurs are extremely common in childhood. No further investigation is required if clinical features are consistent.

Reference: RCH Melbourne – 2024 – Clinical Practice Guidelines: Heart Murmurs