Pericarditis physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

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Physical Examination

Appearance of the Patient with Pericarditis

1. Fever less than 39° C or 102.2° F
   • Patients who are elderly may not exhibit fever; however, they may be hypothermic especially those with renal failure.
2. Chills (suppurative pericarditis and idiopathic (viral) pericarditis)
3. Weakness
4. Depression
5. Anxiety
6. Pallor (may also indicate tuberculosis, uremia, neoplasia, and rheumatic carditis)

Heart

Ausculatory Phenomena:

1. Pericardial Rub(s): Usually heard with acute pericarditis, sometimes with subacute and chronic. This is the major indicator of pericarditis.
   • endopericardial rub: inflamed, scarred or tumor-invaded serosal surfaces
   • exopericardial rub: after sclerotherapy of effusions, between parietal pericardium and pleura or chest wall (occasionally)
   • endo-exopericardial rub: both of the above
   • pleuropericardial rub: pleuritis as a result of pleural or both pleural and pericardial both
2. Abnormal Heart Sounds:
   • Sounds are dampened as a result of fluid insullation
   • Hemodynamic changes diminish S₁ and S₂
3. Clicks: Ventricular volume shrinks disproportionately and psuedoprolapse/true prolapse of mitral and/or tricuspid valvular structures result in clicks.
4. Murmurs: are epiphenomena and may be present if there is coinciding heart disease, narrowing of a valve, aorta, pulmonary artery or another area of the heart.

Lungs

Rales are frequent examination findings, occasionally pleural fluid may present.

Extremities

1. May be poorly perfused in the setting of tamponade
2. Edema may be present in the setting of pericardial constriction

See Also

• Hemopericardium
• Pneumopericardium
• Chylopericardium
• Pericardial effusion
• Congenital absence of the pericardium
• Pericardial window
• Pericardial sac
• Pericardial friction rub
• Pericardiectomy
• Pericardiocentesis
• Pericardium

Acknowledgements

The content on this page was first contributed by C. Michael Gibson, M.S., M.D.

Additional Resources

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Suggested Links and Web Resources

• Pericarditis - Mayo Clinic series
• Pericarditis - cardiologychannel.com
• Pericarditis information from Seattle Children's Hospital Heart Center
• Pulsus paradoxus - Journal of Postgraduate Medicine
• http://en.wikipedia.org/wiki/Pericarditis
• SeeMyHeart - Patient Information on Echocardiograms (Heart Ultrasounds)
• American Society of Echocardiography
• Stress Test with Echocardiography from Angioplasty.Org
• Echocardiography information from Children's Hospital Heart Center, Seattle.
• Coronary heart disease And echocardiography
• Echocardiography Resources Simple echocardiography tutorials
• Atlas of Echocardiography Echocardiography Database
• E-chocardiography Internet Journal of Cardiac Ultrasound
• Echobasics Basic introduction to echocardiography - German/Spanish English planned for 2007
• Echocardiography Basic information about echocardiography - HealthwoRx

For Patients

• Pericarditis

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