Pericardial rub is highly specific for acute pericarditis. In addition to a patient's history and investigations, I learned the importance of identifying pericardial friction rubs on physical exam.
The pericardial rub is produced when the heart rubs against the pericardium. There are 3 phases to this caused by the three largest movements of the heart:
1. Ventricular systole
2. Ventricular diastole
3. Atrial systole
This tri-phasic pericardial rub is pathognomonic for acute pericarditis. Unfortunately, a monophasic pericardial rub is the most commonly identified on physical exam.
Other important characteristics of the pericardial rub:
1. Transient
2. Loudest over the LLSB
3. Better detected with forward leaning and forced expiration
-BH-
Resources:
1. Harvey teaching
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