Pericardial Friction Rub

How to Cite This Chapter: Ibrahim O, Sibbald M, Szczeklik W, Leśniak W. Pericardial Friction Rub. McMaster Textbook of Internal Medicine. Kraków: Medycyna Praktyczna. Accessed June 19, 2024.
Last Updated: December 14, 2020
Last Reviewed: April 10, 2021
Chapter Information

1. Mechanism: Rubbing of pericardial layers covered by fibrin.

2. Causes: Pericarditis.

3. Auscultation: Pericardial friction rub is similar to scratching or squeaking of snow. It consists of 2 or 3 short components per 1 cardiac cycle (1 component sound in systole and 1-2 in diastole). Usually it is best audible near the left sternal border in the second or third intercostal space; often it is audible only over a very limited area. Patients with atrial fibrillation have a biphasic rub due to the absence of atrial contraction. Pericardial friction rub is intensified by firmly pressing the diaphragm of the stethoscope against the skin, in a knee-chest position, and by holding breath on inspiration. It is a transient feature (continuing to disappear and reappear). Pericardial friction rub should be differentiated from the sounds produced by rubbing the stethoscope against hair on the patient’s chest.

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