From the Guidelines
To auscultate for a pericardial friction rub, place your stethoscope at the left lower sternal border with the patient leaning forward and holding their breath after exhaling. This position brings the heart closer to the chest wall, making the friction rub more audible. A pericardial friction rub is a scratchy, grating sound caused by inflamed pericardial layers rubbing against each other during cardiac movement. It typically has three components corresponding to atrial systole, ventricular systole, and ventricular diastole, though all three components may not always be present, as noted in the guidelines on the diagnosis and management of pericardial diseases by the European Society of Cardiology 1. The rub is best heard with the diaphragm of the stethoscope using firm pressure. Unlike heart murmurs, friction rubs are superficial sounds that don't radiate widely and may vary in intensity with respiration or positional changes. They can be transient and may disappear as pericardial effusion develops, so repeated examinations may be necessary if pericarditis is suspected but no rub is initially heard. Key characteristics of the pericardial friction rub include:
- A scratchy, grating sound
- Typically three components corresponding to different phases of the cardiac cycle
- Best heard with the diaphragm of the stethoscope
- May vary in intensity with respiration or positional changes
- Can be transient and may disappear as pericardial effusion develops, as discussed in the European Heart Journal 1.
From the Research
Auscultation Location for Pericardial Friction Rub
To diagnose pericarditis, a pericardial friction rub is a key clinical finding. The location for auscultation of this rub is crucial for accurate diagnosis.
- The pericardial friction rub can be auscultated at the left lower sternal border 2.
- This location is characteristic for pericarditis, allowing for differentiation from other causes of chest pain.
- The presence of a pericardial friction rub, along with other clinical findings such as pleuritic chest pain, can aid in the diagnosis of pericarditis 2, 3.
- It is essential to note that the clinical course and prognosis of pericarditis can vary, and the presence of a pericardial friction rub does not necessarily indicate a poor prognosis 3.
- The diagnosis of pericarditis is often based on a combination of symptoms, clinical signs, and investigations, including electrocardiography and echocardiography 2, 4.