Pericardial friction rub

A pericardial friction rub, also pericardial rub, is an audible medical sign used in the diagnosis of pericarditis.^[1] Upon auscultation, this sign is an extra heart sound of to-and-fro character, typically with three components, one systolic and two diastolic. It resembles the sound of squeaky leather and often is 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. The sound usually is best heard between the apex and sternum but may be widespread.

Cause

The pericardium is a double-walled sac around the heart. The inner and outer (visceral and parietal, respectively) layers are normally lubricated by a small amount of pericardial fluid, but the inflammation of pericardium causes the walls to rub against each other with audible friction. In children, rheumatic fever is often the cause of pericardial friction rub.

Differential diagnosis

Pericardial friction rub is one of several, similar sounds. A differential diagnosis may be possible, or not, depending upon the number of components that are audible. Pericardial friction rub may have one, two, or three audible components, whereas the similar pleural friction rub ordinarily has two audible components. One- and two-component rubs are ambiguous. A three-component rub distinguishes a pericardial rub and indicates the presence of pericarditis. Also, a pleural rub can only be heard during inspiration and expiration, whereas, the pericardial rub can be heard even after cessation of breathing. Pleural rub creates pain mostly on the lateral part of the chest wall, whereas pain due to pericardial rub is always central in location. The intensity of pleural rub is increased on pressing the diaphragm of the stethoscope over the affected area, whereas there is no such change in case of a pericardial rub.

References

↑ Tingle LE, Molina D, Calvert CW (November 2007). "Acute pericarditis". Am Fam Physician 76 (10): 1509–14. PMID 18052017.

Heart disease	Cardiovascular chest pain referred pain Tachycardia/Bradycardia Palpitation Apex beat Cœur en sabot Jugular venous pressure Cannon A waves Carotid bruit

Auscultation	Heart sounds Split S2 Third heart sound Fourth heart sound Gallop rhythm Heart murmur Systolic Diastolic Continuous Pericardial friction rub Heart click

Pulse	Pulsus tardus et parvus Pulsus paradoxus doubled Pulsus bisferiens Dicrotic pulse Pulsus bigeminus Pulsus alternans

Vascular disease	Bruit necrosis Gangrene

Myeloid/blood

Shock	Cardiogenic Hypovolemic Distributive Septic Neurogenic

Hyperaemia	Functional Reactive

Anemia	Pagophagia

Index of the heart

Description	Anatomy Physiology Development

Disease	Injury Congenital Neoplasms and cancer Other Symptoms and signs eponymous Blood tests

Treatment	Procedures Drugs glycosides other stimulants antiarrhythmics vasodilators

Index of the circulatory system

Description	Anatomy Arteries head and neck arms chest abdomen legs Veins head and neck arms chest abdomen and pelvis legs Development Cells Physiology proteins

Disease	Congenital Neoplasms and cancer Lymphatic vessels Injury Vasculitis Other Symptoms and signs eponymous

Treatment	Procedures Drugs beta blockers channel blockers diuretics nonsympatholytic vasodilatory antihypertensives peripheral vasodilators renin–angiotensin system sympatholytic antihypertensives vasoprotectives

Index of cells from bone marrow

Description	Immune system Cells Physiology coagulation proteins granule contents colony-stimulating heme and porphyrin metabolism intermediates

Disease	Red blood cell Monocyte and granulocyte Neoplasms and cancer Histiocytosis Symptoms and signs eponymous Blood tests findings

Treatment	Transfusion Drugs thrombosis bleeding other

Pericardial friction rub

Cause

Differential diagnosis

References

See also