Pericardial friction rub

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A pericardial friction rub, also pericardial rub, is an audible medical sign used in the diagnosis of pericarditis. Upon auscultation, this sign is an extra heart sound of to-and-fro character, typically with three components, two systolic and one diastolic. [1] It resembles the sound of squeaky leather and often is described as grating, scratching, or rasping. The sound seems very close to the ear and may seem louder than or may even mask the other heart sounds. The sound usually is best heard between the apex and sternum but may be widespread.

Contents

Cause

The pericardium is a double-walled sac around the heart. The inner and outer (visceral and parietal, respectively) layers are normally lubricated by a small amount of pericardial fluid, but the inflammation of pericardium causes the walls to rub against each other with audible friction. In children, rheumatic fever is often the cause of pericardial friction rub. Pericardial friction rubs can also be heard in pericarditis that is associated with uremia or post-myocardial infarction.

Differential diagnosis

Pericardial friction rub is one of several, similar sounds. A differential diagnosis may be possible, or not, depending upon the number of components that are audible. Pericardial friction rub may have one, two, or three audible components, whereas the similar pleural friction rub ordinarily has two audible components. One- and two-component rubs are ambiguous. A three-component rub distinguishes a pericardial rub and indicates the presence of pericarditis. Also, a pleural rub can only be heard during inspiration, whereas, the pericardial rub can be heard even after cessation of breathing. Pleural rub creates pain mostly on the lateral part of the chest wall, whereas pain due to pericardial rub is always central in location. The intensity of pleural rub is increased on pressing the diaphragm of the stethoscope over the affected area, whereas there is no such change in case of a pericardial rub.

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<span class="mw-page-title-main">Pericardium</span> Double-walled sac containing the heart and roots of the great vessels

The pericardium, also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong inelastic connective tissue, and an inner layer made of serous membrane. It encloses the pericardial cavity, which contains pericardial fluid, and defines the middle mediastinum. It separates the heart from interference of other structures, protects it against infection and blunt trauma, and lubricates the heart's movements.

<span class="mw-page-title-main">Cardiac tamponade</span> Buildup of fluid around the heart

Cardiac tamponade, also known as pericardial tamponade, is a compression of the heart due to pericardial effusion. Onset may be rapid or gradual. Symptoms typically include those of obstructive shock including shortness of breath, weakness, lightheadedness, and cough. Other symptoms may relate to the underlying cause.

<span class="mw-page-title-main">Pleurisy</span> Disease of the lungs

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<span class="mw-page-title-main">Constrictive pericarditis</span> Medical condition

Constrictive pericarditis is a medical condition characterized by a thickened, fibrotic pericardium, limiting the heart's ability to function normally. In many cases, the condition continues to be difficult to diagnose and therefore benefits from a good understanding of the underlying cause.

<span class="mw-page-title-main">Pericarditis</span> Medical condition

Pericarditis is inflammation of the pericardium, the fibrous sac surrounding the heart. Symptoms typically include sudden onset of sharp chest pain, which may also be felt in the shoulders, neck, or back. The pain is typically less severe when sitting up and more severe when lying down or breathing deeply. Other symptoms of pericarditis can include fever, weakness, palpitations, and shortness of breath. The onset of symptoms can occasionally be gradual rather than sudden.

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Pericardiocentesis (PCC), also called pericardial tap, is a medical procedure where fluid is aspirated from the pericardium.

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<span class="mw-page-title-main">Serous membrane</span> Smooth coating lining contents & inner walls of body cavities

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A pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. The pericardium is a two-part membrane surrounding the heart: the outer fibrous connective membrane and an inner two-layered serous membrane. The two layers of the serous membrane enclose the pericardial cavity between them. This pericardial space contains a small amount of pericardial fluid. The fluid is normally 15-50 mL in volume. The pericardium, specifically the pericardial fluid provides lubrication, maintains the anatomic position of the heart in the chest, and also serves as a barrier to protect the heart from infection and inflammation in adjacent tissues and organs.

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<span class="mw-page-title-main">Third heart sound</span> Medical condition

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A pleural friction rub, or simply pleural rub, is an audible medical sign present in some patients with pleurisy and other conditions affecting the chest cavity. It is noted by listening to the internal sounds of the body, usually using a stethoscope on the lungs.

<span class="mw-page-title-main">Postpericardiotomy syndrome</span> Medical condition

Postpericardiotomy syndrome (PPS) is a medical syndrome referring to an immune phenomenon that occurs days to months after surgical incision of the pericardium. PPS can also be caused after a trauma, a puncture of the cardiac or pleural structures, after percutaneous coronary intervention, or due to pacemaker or pacemaker wire placement.

<span class="mw-page-title-main">Chest pain in children</span> Medical condition

Chest pain in children is the pain felt in the chest by infants, children and adolescents. In most cases the pain is not associated with the heart. It is primarily identified by the observance or report of pain by the infant, child or adolescent by reports of distress by parents or caregivers. Chest pain is not uncommon in children. Many children are seen in ambulatory clinics, emergency departments and hospitals and cardiology clinics. Most often there is a benign cause for the pain for most children. Some have conditions that are serious and possibly life-threatening. Chest pain in pediatric patients requires careful physical examination and a detailed history that would indicate the possibility of a serious cause. Studies of pediatric chest pain are sparse. It has been difficult to create evidence-based guidelines for evaluation.

<span class="mw-page-title-main">Pericardial cyst</span>

A pericardial cyst is an uncommon benign dilatation of the pericardial sac surrounding the heart. It can lead to symptoms by compressing nearby structures, but is usually asymptomatic. Pericardial cysts can be congenital or acquired, and they are typically diagnosed with radiologic imaging. Management of pericardial cysts can include follow-up imaging, percutaneous aspiration, or surgical resection.

References

  1. Tingle LE, Molina D, Calvert CW (November 2007). "Acute pericarditis". Am Fam Physician. 76 (10): 1509–14. PMID   18052017.

See also