Rytand’s murmur in heart block

Rytand’s murmur in heart block

David A Rytand [1] described a diastolic murmur in elderly patients with varying degrees of heart block, which was later known as Rytand’s murmur. Of the total 9 cases reported by him, 4 had calcification of mitral annulus, but without significant obstruction of mitral flow. Remaining 5 of them did not have mitral annular calcification. The description was of a blowing diastolic murmur at the cardiac apex. Simultaneous phonocardiographic and electrocardiographic recordings demonstrated the relationship of the diastolic murmur to atrial activity.

The murmur was better heard in the left lateral position. It was louder when it occurred in the early diastole so as to coincide with the end of early rapid filling period of the ventricle. The murmur is almost equivalent to the summation gallop heard when third heart sound and fourth heart sound overlap. While this occurs in a tachycardia situation, Rytand’s murmur occurs in a bradycardia situation and summation gallop (sometimes nick named as S7 gallop!) is considered as a heart sound while the former is a murmur. But mechanism is similar – louder event is when the rapid ventricular filling phase overlaps with the atrial contraction.

A maximum of two murmurs were recorded in a diastole, in a patient with complete heart block by Rytand. Similar diastolic murmur was described in congenital complete atrioventricular block by Paul MH et al [2].

References

1. Rytand DS. An auricular diastolic murmur with heart block in elderly patients. Am. Heart J. 32: 579, 1946.
2. Paul MH, Rudolph AM, Nadas AS. Congenital complete atrioventricular block: problems of clinical assessment. Circulation. 1958 Aug;18(2):183-90.