Rytand murmur

Description

Rytand murmur: Mid-late blowing diastolic murmur heard occasionally in patients with complete atrioventricular heart block. Best heard at the apex, and often confused with mitral stenosis (no opening snap).

A blowing diastolic murmur heard occasionally in patients with complete atrioventricular heart block. Best heard at the apex and often confused with mitral stenosis, the murmur is loudest when it appears early in diastole (i.e. when it coincides with the end of the early rapid filling period of the ventricle) but may appear anytime during diastole.

History of the Rytand murmur

Rytand was not the first to identify the presence of a diastolic murmur in patients with atrioventricular block without mitral stenosis, with Wolferth and Margolies describing its existence in 1930, and Stead and Kunkel describing it in 1939.

Rytand was, however, the first person to describe and characterise the murmur in detail.

Observations are reported on a blowing apical murmur related to auricular activity in nine elderly but ambulatory patients with varying degrees of auriculoventricular block.

…another murmur which may be heard at the cardiac apex during diastole in the absence of mitral stenosis.

Rytand 1946

Associated Persons

• David Abramson Rytand (1909–1991)

Alternative names

• La maladie de Rytand

References

Original articles

• Woolferth CC, Margolies A. The influence of auricular contraction on the first heart sound and the radial pulse. Arch Int Med (Chic). 1930; 46(6): 1048–1071. 
• Stead EA, Kunkel P. Factors influencing the auricular murmur and the intensity of the first heart sound. American Heart Journal. 1939; 18(3); 261-270
• Rytand DA. An auricular diastolic murmur with heart block in elderly patients. American Heart Journal. 1946; 32: 579-598

Review articles

• Paul MH, Rudolph AM, Nadas AS. Congenital complete atrioventricular block: problems of clinical assessment. Circulation. 1958 Aug;18(2):183-90.
• Jelveh M, Berger M, Goldberg E. The genesis of the diastolic murmur of complete heart block. Phono-echocardiographic observations. Circulation. 1978 Oct;58(4):747-50.
• Robbins A, Zhang G, Cadogan M. Name that murmur. LITFL 2022
• Cadogan M. Rytand murmur. Eponym A Day. Instagram

Lewis Hong

Lewis is an RMO at Royal Perth Hospital. He is currently interested in critical care medicine.

Mike Cadogan

Associate Professor Curtin Medical School, Curtin University. Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM Sir Charles Gairdner Hospital.  Passion for rugby; medical history; medical education; and asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | Twitter |