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Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Elsevier; 2019.
Bickley LS, Szilagyi PG. Bates’ Guide to Physical Examination and History-Taking. 11th ed. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2013.
Simel DL, Rennie D, Keitz SA. The Rational Clinical Examination: Evidence-Based Clinical Diagnosis. McGraw-Hill; 2009.
Walker HK, Hall WD, Hurst JW. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Butterworths; 1990.
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.
