Pericardial friction rub

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 is often loud and 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 of Underlying Causes
In alphabetical order.


 * Amyloidosis
 * Cardiac tamponade
 * Collagen Vascular Disease
 * Dressler's syndrome
 * Familial Mediterranean Fever
 * HIV
 * Leukemic infiltration
 * Mediastinal radiation
 * Mediastinal emphysema
 * Myocardial Infarction
 * Myocarditis
 * Neoplasm
 * Parasitic infection
 * Pleuropericardial rub
 * Pericarditis
 * Rheumatic Fever
 * Sarcoidosis
 * Sail sound of Ebstein's anomaly
 * Thyrotoxicosis
 * Toxoplasmosis
 * Trauma
 * Tuberculosis
 * Uremia
 * Viral

History and Symptoms
History includes:
 * Recent viral exposure
 * Fever
 * Trauma

Physical Examination
A careful exam should be conducted to evaluate the patient for signs of cardiac tamponade.

Below is the video demonstrating Pericardial friction rub:



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
Depending upon the underlying cause and if an effusion is present, the chest x ray may show signs of cardiomegaly

Echocardiography or Ultrasound
If there is a clinical suspicion of cardiac tamponade, and echocardiogram should be performed to assess the size of the effusion, to guide pericardiocentesis.

Treatment

 * Hemodynamic stability is intact
 * Supplemental oxygen

Acute Pharmacotherapies

 * Pericarditis: NSAIDs

Indications for Surgery
An emergency pericardiocentesis is indicated in the presence of cardiac tamponade, a large symptomatic pericardial effusion, or to establish the diagnosis in a case of suspected malignant or tuberculous pericarditis.