Pericardial friction rub

(Redirected from Pericardial rub)
Jump to navigation Jump to search

WikiDoc Resources for Pericardial friction rub


Most recent articles on Pericardial friction rub

Most cited articles on Pericardial friction rub

Review articles on Pericardial friction rub

Articles on Pericardial friction rub in N Eng J Med, Lancet, BMJ


Powerpoint slides on Pericardial friction rub

Images of Pericardial friction rub

Photos of Pericardial friction rub

Podcasts & MP3s on Pericardial friction rub

Videos on Pericardial friction rub

Evidence Based Medicine

Cochrane Collaboration on Pericardial friction rub

Bandolier on Pericardial friction rub

TRIP on Pericardial friction rub

Clinical Trials

Ongoing Trials on Pericardial friction rub at Clinical

Trial results on Pericardial friction rub

Clinical Trials on Pericardial friction rub at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Pericardial friction rub

NICE Guidance on Pericardial friction rub


FDA on Pericardial friction rub

CDC on Pericardial friction rub


Books on Pericardial friction rub


Pericardial friction rub in the news

Be alerted to news on Pericardial friction rub

News trends on Pericardial friction rub


Blogs on Pericardial friction rub


Definitions of Pericardial friction rub

Patient Resources / Community

Patient resources on Pericardial friction rub

Discussion groups on Pericardial friction rub

Patient Handouts on Pericardial friction rub

Directions to Hospitals Treating Pericardial friction rub

Risk calculators and risk factors for Pericardial friction rub

Healthcare Provider Resources

Symptoms of Pericardial friction rub

Causes & Risk Factors for Pericardial friction rub

Diagnostic studies for Pericardial friction rub

Treatment of Pericardial friction rub

Continuing Medical Education (CME)

CME Programs on Pericardial friction rub


Pericardial friction rub en Espanol

Pericardial friction rub en Francais


Pericardial friction rub in the Marketplace

Patents on Pericardial friction rub

Experimental / Informatics

List of terms related to Pericardial friction rub

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]


The pericardial friction rub, also pericardial rub, is a sign on the precordial exam, detected by auscultation, that suggests irritation of the pericardium and the diagnosis of pericarditis. Inflammation of the pericardial sac causes the parietal and visceral surfaces of the roughened pericardium to rub against each other. This produces an extra cardiac sound of to-and-fro character with both systolic and diastolic components. One, two, or three components of a pericardial friction rub may be audible. A three-component rub indicates the presence of pericarditis and serves to distinguish a pericardial rub from a pleural friction rub, which ordinarily has two components. It resembles the sound of squeaky leather and is often described as grating, scratching, or rasping. The sound is often loud and may even mask the other heart sounds. Friction rubs are usually best heard between the apex and sternum but may be widespread. The sound has three parts: two diastolic, and one systolic, more specifically: atrial systole, rapid-filling phase of the ventricle and ventricular systole. A one-component rub, usually during ventricular systole, is suggestive of myopericarditis following transmural myocardial infarction.


Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

[1] [2]

Causes by Organ System

Cardiovascular Acute mediastinal emphysema, cardiac tamponade, collagen vascular disease, dilated cardiomyopathy, dissecting aortic aneurysm, Dressler's syndrome, heart surgery, mediastinal emphysema, myocardial infarction, myocardial rupture, myocarditis, myxedema, neoplasm, parasitic infection, pericarditis, pleuropericardial rub, rheumatic fever, sail sound of ebstein's anomaly, sarcoidosis, scrub typhus, thyrotoxicosis, toxoplasmosis, ventricular aneurysm, viral
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Cytarabine, Procainamide
Ear Nose Throat No underlying causes
Endocrine Hypothyroidism, myxedema, thyrotoxicosis
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Amyloidosis, bronchogenic cyst, collagen vascular disease, dilated cardiomyopathy, dissecting aortic aneurysm, familial mediterranean fever, hypothyroidism, sail sound of ebstein's anomaly, ventricular aneurysm
Hematologic Leukemic infiltration
Iatrogenic Balloon flotation catheter, heart surgery, inadvertent entry of air into the right ventricular cavity, mediastinal radiation, procainamide, transvenous pacing catheter, twitching of the intercostal muscles or of the diaphragm during artificial pacing
Infectious Disease HIV, mycobacterium tuberculosis, myocarditis, parasitic infection, pericarditis, rheumatic fever, scrub typhus, toxoplasmosis, tuberculosis, viral
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic Uremia
Obstetric/Gynecologic No underlying causes
Oncologic Leukemic infiltration, neoplasm
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Acute mediastinal emphysema, pleuropericardial rub
Renal/Electrolyte Uremia
Rheumatology/Immunology/Allergy Dressler's syndrome, familial mediterranean fever, rheumatic fever, sarcoidosis
Sexual No underlying causes
Trauma Dissecting aortic aneurysm, Dressler's syndrome, trauma
Urologic No underlying causes
Miscellaneous Swallowing sounds

Causes in Alphabetical Order


History and Symptoms

History includes:

Physical Examination

Considering that several causes, mentioned above, can be responsible for the presence of a pericardial rub on auscultation, a full physical exam should be performed, in order to gather every sign, for appropriate differential diagnosis. A careful exam should be conducted to evaluate the patient for signs of life-threatening situations, such as cardiac tamponade. Pericardial rubs are best heard with the diaphragm of the stethoscope, and can be described according to:[3]

  • Location: although variable, it is usually best heard in the 3rd interspace to the left of the sternum;
  • Radiation: little;
  • Intensity: although variable, it may increase with the patient leaning forward, when exhaling or holding breath (contrast with pleural rub);
  • Quality: scratching and grating;
  • Pitch: high

The pericardial rub sound usually varies in intensity over time, therefore auscultation should be performed at several occasions.[4]

Below is the video demonstrating Pericardial friction rub:


Laboratory Findings

  • Labs include:


ECG for potential MI, pericarditis or other cardiac problems

Chest X Ray

Depending upon the underlying cause and if an effusion is present, the chest x-ray may show signs of cardiomegaly

Echocardiography or Ultrasound

If there is a clinical suspicion of cardiac tamponade, and echocardiogram should be performed to assess the size of the effusion, to guide pericardiocentesis.

Cardiac Computed Tomography and Cardiac Magnetic Resonance

Cardiac Computed Tomography and Cardiac Magnetic Resonance are gaining more importance in the diagnosis of pericarditis. Both are very sensitive methods in diagnosing effusions, as well as in determining pericardial thickness.[4]


  • Hemodynamic stability is intact
  • Supplemental oxygen

Acute Pharmacotherapies

Indications for Surgery

An emergency pericardiocentesis is indicated in the presence of cardiac tamponade, a large symptomatic pericardial effusion, or to establish the diagnosis in a case of suspected malignant or tuberculous pericarditis.


  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
  3. Bickley, Lynn S.; Szilagyi, Peter G.; Bates, Barbara (2009). Bates' guide to physical examination and history taki. Philadelphia: Wolters Kluwer Health/Lippincott Williams Wilkins. ISBN 0-7817-8058-6.
  4. 4.0 4.1 Khandaker MH, Espinosa RE, Nishimura RA, Sinak LJ, Hayes SN, Melduni RM et al. (2010) Pericardial disease: diagnosis and management. Mayo Clin Proc 85 (6):572-93. DOI:10.4065/mcp.2010.0046 PMID: 20511488

See also

Template:WikiDoc Sources