a u s c u l t a t i o n    t u t o r
Pericardial friction rub


The sound arises from two inflamed pericardial surfaces rubbing together. Rubs may occur with a pericardial
effusion since effusions often do not cover the entire pericardium. Listen to the precordium during deep
expiration with the patient prone or sitting and leaning forward. Rubs are scratchy, grating, rasping, or
squeaky. In approximately half the cases, the sound is triphasic, heard in systole and early and late diastole.
In approximately one-third of patients it is systolic and late diastolic. In the remainder, it is heard only in
systole; often it is intermittent. Rubs seem closer to the ear than murmurs. Causes are infectious pericarditis,
myocardial infarction or cardiac surgery, uremia, carcinoma metastatic to pericardium, and, rarely, pulmonary
infarction.
t h e     h e a r t
Normal Cardiac Cycle
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