Today we heard a pericardial rub.
So what is the first thing to do when you hear one of these? Go find your friend and get them to listen to it too. Pericardial rubs are notoriously transient, and when your attending looks at you with disdain the next day as he or she hears normal heart sounds, you've got your friend to back you up that it indeed was present at 3:00 am.
What does it sound like? "leather on leather".....kind of like in that movie you saw but won't admit to anybody.
Where is it most commonly heard? At the left sternal boarder.
Phases to the rub? you may hear three components of the rub, correlating with 1. atrial systole, 2. ventricular systole, and 3. ventricular diastole. Just over 50% of rubs have 3 phases, and you can hear 2 phases in another 30%.
When do you hear this? A common finding in pericarditis. You will see it with the following conditions:
- Idiopathic: common - likely viral.
- Infectious: Viral (common), TB (also common) bacterial (uncommon), fungal
- Autoimmune: SLE, rheumatic fever, drug induced lupus
- Metabolic: Uremia
- Malignant: eg lung or breast cancer with metastases, lymphoma
- Radiation
- Post MI: Dressler's syndrome
- Structural: aortic dissection with blood leaking into pericardium, post pericardiotomy, post cardiac surgery, post trauma
Here is a very good review of pericarditis.
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