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 one another. Ranging from faint to loud, this abnormal sound is best heard along the lower left sternal border during deep inspiration. It indicates pericarditis, which can result from an 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 472.) or a pleural friction rub. However, the classic pericardial friction rub has three components. (See Understanding pericardial friction rubs, page 473.)
History and physical examination
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 a 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?
Take the patient's vital signs, noting especially hypotension, tachycardia, an irregular pulse, tachypnea, and fever. Inspect for jugular vein distention, edema, ascites, and hepatomegaly. Auscultate the lungs for crackles. (See Comparing auscultation findings, pages 474 and 475.)
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.
Nursing considerations
▪ Monitor the patient's cardiovascular status and cardiac rhythm.
▪ If the pericardial friction rub disappears, be alert for signs of cardiac tamponade.
▪ If the patient develops cardiac tamponade, prepare him 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.
Patient teaching
▪ Teach the patient about the disorder and treatment plan.
▪ Teach about prescribed medications, including their dosage, administration, and adverse effects.
Pictures
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, 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: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Pericardial effusion
» Next page: Pulse pressure, narrowed (Nursing: Interpreting Signs and Symptoms)
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