Pericardial Friction Rub

  • A pericardial friction rub is the sound that is generated as a result of an inflamed pericardium.
  • Rubs consist of one to three sounds that may be mistaken for murmurs. However, the quality of the sound(s) is different and distinctive, often scratchy or creaky.
  • Classically there are three components to a pericardial rub that correlate with atrial contraction (so you may hear it just before S1), during ventricular systole (between S1 and S2) and during the rapid filling phase of diastole (right after S2).
 

Patient 1:

This is an older woman who was admitted to the hospital with pancytopenia and decompensated heart failure and was found to have a one-component pericardial friction rub of unclear etiology.

Patient 2:

This is a middle-aged woman with idiopathic dilated cardiomyopathy who underwent orthotopic heart transplantation and developed a three-component pericardial friction rub in the post-operative period.

Pericardial Friction Rub

Annotated

Patient 3:

This patient has a three-component pericardial friction rub.

Pericardial Friction Rub

Annotated

Patient 4:

This is an older woman with Sjögren’s syndrome complicated by lymphoma and pauci-immune glomerulonephritis. She developed a three-component pericardial friction rub after progression of the kidney disease. 

Pericardial Friction Rub

Annotated

Patient 5:

This is a middle-aged man with Laennec’s cirrhosis who developed uremia related to hepatorenal syndrome. There is a two-component pericardial friction rub.

Pericardial Friction Rub

Annotated

Patient 6:

This is a middle-aged man with a pericardial friction rub, recorded a day after coronary artery bypass surgery.

Patient 7:

This is an older woman with seronegative rheumatoid arthritis who was admitted to the hospital for unrelated reasons and found to have a pericardial friction rub.