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.
We would love to hear from you
Comments, mistakes, suggestions?