Pericardial friction rub
| Pericardial friction rub |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
The pericardial friction rub, also pericardial rub, is a sign on the precordial exam, detected by auscultation, that suggests irritation of the pericardium and the diagnosis of pericarditis. Inflammation of the pericardial sac causes the parietal and visceral surfaces of the roughened pericardium to rub against each other. This produces an extra cardiac sound of to-and-fro character with both systolic and diastolic components. One, two, or three components of a pericardial friction rub may be audible. A three-component rub indicates the presence of pericarditis and serves to distinguish a pericardial rub from a pleural friction rub, which ordinarily has two components. It resembles the sound of squeaky leather and is often described as grating, scratching, or rasping. The sound seems very close to the ear and may seem louder than or may even mask the other heart sounds. Friction rubs are usually best heard between the apex and sternum but may be widespread. The sound has three parts. Two diastolic, and one systolic.
Differential Diagnosis
In alphabetical order. [1] [2]
- Amyloidosis
- Cardiac tamponade
- Collagen Vascular Disease
- Familial Mediterranean Fever
- HIV
- Ischemia
- Leukemic infiltration
- Mediastinal radiation
- Mediastinal emphysema
- Acute Myocardial Infarction
- Myocarditis
- Neoplasm
- Parasitic infection
- Pleuropericardial rub
- Pulmonary Embolism
- Pericarditis
- Rheumatic Fever
- Sarcoidosis
- Sail sound of Ebstein's anomaly
- Thyrotoxicosis
- Toxoplasmosis
- Trauma
- Tuberculosis
- Uremia
- Viral
Diagnosis
History and Symptoms
- History includes:
- Family
- Personal
- exposures
- recent viral exposure
- fever
- trauma
- Exaggerated pulsus paradoxus
Below is the video demonstrating Pericardial friction rub:
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Laboratory Findings
- Labs include:
- Cardiac enzymes
- CBC w/ differential
- ESR
- ANA
- rheumatoid factor
- BUN / creatinine
- PPD
- viral titers
- ASO titers
Electrocardiogram
- ECG for potential MI, pericarditis or other cardiac problems
Chest X Ray
Echocardiography or Ultrasound
- Echo for pleural effusion
Treatment
- Hemodynamic stability is intact
- Supplemental oxygen
Acute Pharmacotherapies
Indications for Surgery
- Emergency pericardiocentesis to drain effusions of the pericardium in cardiac tamponade
References