Cardiovascular Medicine Book

Pericardial Disorders




Pericardial Friction Rub

Aka: Pericardial Friction Rub
  1. Pathophysiology
    1. Pathognomonic for Pericarditis
    2. Occurs when heart rubs against pericardial sac
  2. 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
  3. Differential Diagnosis
    1. Pleuritis
      1. Monophasic rub during respiration
  4. Efficacy
    1. Test Sensitivity: 85%
    2. Test Specificity: 100% for Acute Pericarditis
  5. References
    1. Spodick (1975) Am J Cardiol 35: 357-62 [PubMed]

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