Pericarditis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

The classic sign of pericarditis is a friction rub. A careful examination must be performed to exclude the presence of cardiac tamponade, a dangerous complication of pericarditis. If cardiac tamponade is present, then pulsus paradoxus, hypotension), an elevated jugular venous pressure and peripheral edema may be present.

Appearance of the Patient with Pericarditis

• Fever less than 39° C or 102.2° F
  • Patients who are elderly may not exhibit fever; however, they may be hypothermic especially those with renal failure.
• Chills (suppurative pericarditis and idiopathic (viral) pericarditis)
• Weakness
• Anxiety
• Pallor (may also indicate tuberculosis, uremia, neoplasia, and rheumatic carditis)

Heart

• Pericardial friction rub: This is the classic physical examination finding in pericarditis. It is usually heard with acute pericarditis, and occasionally with either subacute or chronic pericarditis. There are several differnnt pericardial rubs that can be auscultated:
  • Endopericardial rub: this occurs as the result of inflamed, scarred or tumor-invaded serosal surfaces
  • Exopericardial rub: this occurs after sclerotherapy of effusions, and is due to friction between the parietal pericardium and the pleura (or chest wall occasionally)
  • Endo-exopericardial rub: occurs with both of the above
  • Pleuropericardial rub: occurs as a result of both pleural and pericardial inflammation

Signs that a Significant Pericardial Effusion and/or Cardiac Tamponade May be Present

• If the heart sounds are quite and muffled, then one should suspect that a significant pericardial effusion and potentially cardiac tamponade are present.
• Hemodynamic changes diminish S₁ and S₂
• Clicks: Ventricular volume shrinks disproportionately and psuedoprolapse/true prolapse of mitral and/or tricuspid valvular structures result in clicks.

Lungs

Rales are frequent examination findings, occasionally pleural fluid may present.

Extremities

1. May be poorly perfused in the setting of tamponade
2. Edema may be present in the setting of pericardial constriction

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