Pericardial friction rub
Commonly transient, a pericardial friction rub is a scratching, grating, or crunching sound that occurs when two inflamed layers of the pericardium slide over each other. Ranging from faint to loud, this abnormal sound is best heard along the lower left sternal border during deep inspiration. (See Comparing auscultation findings.) It indicates pericarditis, which can result from acute infection, a cardiac or renal disorder, postpericardiotomy syndrome, or the use of certain drugs.
Occasionally, a pericardial friction rub can resemble a murmur (see Pericardial friction rub or murmur? page 504) or a pleural friction rub. However, the classic pericardial friction rub has three components. (See Understanding pericardial friction rubs, page 505.)
History
Obtain a complete medical history, noting especially cardiac dysfunction. Has the patient recently had a myocardial infarction or cardiac surgery? Has he ever had pericarditis or rheumatic disorder, such as rheumatoid arthritis or systemic lupus erythematosus? Does he have chronic renal failure or an infection? If the patient
complains of chest pain, ask him to describe its character and location. What relieves the pain? What worsens it?
Physical assessment
Take the patient’s vital signs, noting especially hypotension, tachycardia, irregular pulse, tachypnea, and fever. Inspect for jugular vein distention, edema, ascites, and hepatomegaly. Auscultate the lungs for crackles.
Medical causes
Pericarditis
A pericardial friction rub is the hallmark of acute pericarditis. This disorder also causes sharp precordial or retrosternal pain that usually radiates to the left shoulder, neck, and back. The pain worsens when the patient breathes deeply, coughs, or lies flat and, possibly, when he swallows. It abates when he sits up and leans forward. The patient may also develop fever, dyspnea, tachycardia, and arrhythmias.
With chronic constrictive pericarditis, a pericardial friction rub develops gradually and is accompanied by signs of decreased cardiac filling and output, such as peripheral edema, ascites, jugular vein distention on inspiration (Kussmaul’s sign), and hepatomegaly. Dyspnea, orthopnea, paradoxical pulse, and chest pain may also occur.
Other causes
Drugs
Procainamide and chemotherapeutic drugs can cause pericarditis.
Special considerations
Continue to monitor the patient’s cardiovascular status. If the pericardial friction rub disappears, be alert for signs of cardiac tamponade: pallor, hypotension, tachycardia, tachypnea, paradoxical pulse, increased jugular vein distention, and cool, clammy skin. If these signs occur, prepare the patient for pericardiocentesis to prevent cardiovascular collapse.
Ensure that the patient gets adequate rest. Give an anti-inflammatory, antiarrhythmic, diuretic, or antimicrobial to treat the underlying cause. If necessary, prepare him for a pericardiectomy to promote adequate cardiac filling and contraction.
Pediatric pointers
Bacterial pericarditis may develop during the first 2 decades of life, usually before age 6. Although a pericardial friction rub may occur, other signs and symptoms — such as fever, tachycardia, dyspnea, chest pain, jugular vein distention, and hepatomegaly — more reliably indicate this life-threatening disorder. A pericardial friction rub may also occur after surgery to correct congenital cardiac anomalies. However, it usually vanishes without development of pericarditis.
Patient counseling
Explain the underlying disorder and its treatments to the patient. Encourage the patient to sit upright to relieve dyspnea and chest pain. To promote comfort and ease anxiety, reassure the patient with acute pericarditis that his condition is temporary.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Pericardial effusion
Read excerpts from these other book chapters related to Pericardial effusion:
Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Pericardial effusion
» Next page: Pulse pressure, narrowed (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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