II. Pathophysiology

  1. Pathognomonic for Pericarditis
  2. Occurs when heart rubs against pericardial sac

III. Signs

  1. Three phase sound (classic triphasic sound in only 50% of cases)
    1. Atrial systole
    2. Ventricular systole
    3. Ventricular diastole
  2. Transient scratching sound
    1. Rasping sound of leather rubbing against leather
  3. Timing
    1. Transient - requires multiple attempts at auscultation
  4. Locations to best hear friction rub
    1. Apply stethoscope diaphragm to left lower sternal border
    2. Patient leaning forward
    3. At end of exhalation

IV. Differential Diagnosis

  1. Pleuritis
    1. Monophasic rub during respiration

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