Pericardial friction rub
Pericardial friction rub: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
Commonly transient, a pericardial friction rub is a scratching, grating, or crunching sound that occurs when two inflamed layers of the pericardium slide over one another. Ranging from faint to loud, this abnormal sound is best heard along the lower left sternal border during deep inspiration. (See Comparing auscultation findings, pages 608 and 609.) It indicates pericarditis, which can result from acute infection, a cardiac or renal disorder, postpericardiotomy syndrome, or the use of certain drugs.
Occasionally, a pericardial friction rub can resemble a murmur (see Pericardial friction rub or murmur?) or a pleural friction rub. However, the classic pericardial friction rub has three components. (See Understanding pericardial friction rubs, page 610.)
History and physical examination
Obtain a complete medical history, noting especially cardiac dysfunction. Has the patient recently had a myocardial infarction or cardiac surgery? Has he ever had pericarditis or rheumatic disorder, such as rheumatoid arthritis or systemic lupus erythematosus? Does he have chronic renal failure or an infection? If the patient complains of chest pain, ask him to describe its character and location. What relieves the pain? What worsens it?
Take the patient’s vital signs, noting especially hypotension, tachycardia, irregular pulse, tachypnea, and fever. Inspect for jugular vein distention, edema, ascites, and hepatomegaly. Auscultate the lungs for crackles.
Medical causes
Pericarditis
A pericardial friction rub is the hallmark of acute pericarditis. This disorder also causes sharp precordial or retrosternal pain that usually radiates to the left shoulder, neck, and back. The pain worsens when the patient breathes deeply, coughs, or lies flat and, possibly, when he swallows. It abates when he sits up and leans forward. The patient may also develop fever, dyspnea, tachycardia, and arrhythmias.
With chronic constrictive pericarditis, a pericardial friction rub develops gradually and is accompanied by signs of decreased cardiac filling and output, such as peripheral edema, ascites, jugular vein distention on inspiration (Kussmaul’s sign), and hepatomegaly. Dyspnea, orthopnea, paradoxical pulse, and chest pain may also occur.
Other causes
Drugs
Procainamide and chemotherapeutic drugs can cause pericarditis.
Special considerations
Continue to monitor the patient’s cardiovascular status. If the pericardial friction rub disappears, be alert for signs of cardiac tamponade: pallor; cool, clammy skin; hypotension; tachycardia; tachypnea; paradoxical pulse; and increased jugular vein distention. If these signs occur, prepare the patient for pericardiocentesis to prevent cardiovascular collapse.
Ensure that the patient gets adequate rest. Give an anti-inflammatory, antiarrhythmic, diuretic, or antimicrobial to treat the underlying cause. If necessary, prepare him for a pericardiectomy to promote adequate cardiac filling and contraction.
Pediatric pointers
Bacterial pericarditis may develop during the first two decades of life, usually before age 6. Although a pericardial friction rub may occur, other signs and symptoms—such as fever, tachycardia, dyspnea, chest pain, jugular vein distention, and hepatomegaly—more reliably indicate this life-threatening disorder. A pericardial friction rub may also occur after surgery to correct congenital cardiac anomalies. However, it usually vanishes without development of pericarditis.
Pictures
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
More About Pericarditis
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Medical Books Excerpts
- Myocarditis
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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