**Question:** Rytand's murmur is seen in -

**Core Concept:** Rytand's murmur is a rare, innocent murmur that occurs in individuals with a congenital bicuspid aortic valve. It is named after the Swedish physician, Tage Rytand, who first described this murmur.

**Why the Correct Answer is Right:** Rytand's murmur is a low-pitched, continuous murmur heard at the left lower sternal border, and it is characterized by its rhythmic, diastolic component. It is present in individuals with a congenital bicuspid aortic valve, where the aortic valve has two cusps rather than the usual three. This murmur arises due to the turbulent flow between the two cusps during diastole, leading to the characteristic low-pitched and rhythmic murmur.

**Why Each Wrong Option is Incorrect:**

A. Mitral stenosis: This murmur is characterized by a high-pitched, systolic murmur heard at the left lower sternal border, reflecting the narrowing of the mitral valve.

B. Pulmonary stenosis: This murmur is a high-pitched, systolic murmur heard best at the left lower sternal border and is caused by the narrowing of the pulmonary valve.

C. Aortic stenosis: The murmur associated with aortic stenosis is a high-pitched, systolic murmur heard at the left lower sternal border, reflecting the narrowing of the aortic valve.

D. Aortic regurgitation: This murmur is a continuous, holosystolic murmur heard at the left lower sternal border, reflecting the regurgitation of blood from the aortic valve into the aorta.

**Clinical Pearl:** Rytand's murmur is a benign finding in individuals with a congenital bicuspid aortic valve, indicating that the murmur is part of the normal physiology of the bicuspid aortic valve and does not require further evaluation unless associated symptoms or signs of aortic regurgitation or stenosis are present.

**Correct Answer:** None of the options (D)

**Explanation:** Rytand's murmur is a characteristic finding in patients with congenital bicuspid aortic valve, which is a normal physiological phenomenon and does not require further evaluation unless associated symptoms, signs of aortic regurgitation or stenosis are present. The murmur is caused by the turbulent flow between the two cusps of the bicuspid aortic valve during diastole. This murmur is not seen in the options A, B, C, and D, which are associated with specific pathologies involving the mitral, pulmonary, aortic stenosis or aortic regurgitation, respectively.

In contrast, Rytand's murmur is a normal physiological finding and does not require further evaluation unless it is associated with symptoms or signs of aortic regurgitation or stenosis.