Exam

Pericardial Friction Rub

search

Pericardial Friction Rub

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