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Pericardial Friction Rub

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1. Pericardial Friction Rub

Pericardial Friction Rub Pericardial Friction Rub Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Pericardial Friction Rub Pericardial (...) Friction Rub Aka: Pericardial Friction Rub From Related Chapters II. Pathophysiology Pathognomonic for Occurs when heart rubs against pericardial sac III. Signs Three phase sound (classic triphasic sound in only 50% of cases) Atrial systole Ventricular systole Ventricular diastole Transient scratching sound Rasping sound of leather rubbing against leather Timing Transient - requires multiple attempts at auscultation Locations to best hear friction rub Apply stethoscope diaphragm to left lower sternal

2018 FP Notebook

2. Pericardial fremitus – palpable pericardial rub

Pericardial fremitus – palpable pericardial rub Pericardial fremitus – palpable pericardial rub – All About Cardiovascular System and Disorders Now Trending: | November 24, 2017 | | Pericardial fremitus – palpable pericardial rub A palpable pericardial rub is known as pericardial fremitus. It is due to the friction between the parietal and visceral layers of the pericardium. Some authors use the term as synonymous with pericardial rub [1,2]. The auscultatory counterpart of pericardial fremitus (...) is the pericardial rub. Pericardial rub has a characteristic triphasic nature. The three phases of pericardial rub has been described as systolic, diastolic and atrial systolic. All the three components may not be audible always. Pericardial rub is known to be evanescent and requires careful auscultation for detection sometimes. In uremic pericarditis is usually quite loud and easily audible. Reference Miltgen J et al. . Emerg Infect Dis. 2002 Nov; 8(11): 1350–1352. Box CR et al. Statistics of Pericarditis

2017 Cardiophile MD blog

3. Pericardial Friction Rub

Pericardial Friction Rub Pericardial Friction Rub Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Pericardial Friction Rub Pericardial (...) Friction Rub Aka: Pericardial Friction Rub From Related Chapters II. Pathophysiology Pathognomonic for Occurs when heart rubs against pericardial sac III. Signs Three phase sound (classic triphasic sound in only 50% of cases) Atrial systole Ventricular systole Ventricular diastole Transient scratching sound Rasping sound of leather rubbing against leather Timing Transient - requires multiple attempts at auscultation Locations to best hear friction rub Apply stethoscope diaphragm to left lower sternal

2015 FP Notebook

4. CRACKCast E082 – Pericardial & Myocardial Disease

Post MI, cardiac surgery, thoracic sx, trauma – penetrating injury Usually appears 4-12 days post Metabolic Systemic autoimmune diseases Tumours Aortic dissection 2) Describe typical pain of pericarditis & expected labwork abnormalities Chest pain Sharp Pleuritic Varies with position Relieved by sitting forward and worse lying down/deep breath in/swallowing May radiate to shoulders/diaphragm Hx of fevers and myalgia The friction rub – is typically only heard in sound-proofed cardiologists offices (...) CRACKCast E082 – Pericardial & Myocardial Disease CRACKCast E082 - Pericardial & Myocardial Disease - CanadiEM CRACKCast E082 – Pericardial & Myocardial Disease In , by Adam Thomas June 1, 2017 This episode of CRACKCast covers Rosen’s Chapter 82, Pericardial & Myocardial Disease. This episode covers two diseases that can be challenging both in diagnosis and management and how to approach them in the ED. Shownotes – Rosen’s in Perspective These are challenging diseases — both in managing

2017 CandiEM

5. Pericardial Effusion (Diagnosis)

friction rub Tachycardia Hepatojugular reflux Tachypnea Decreased breath sounds Ewart sign: Dullness to percussion beneath the angle of left scapula Hepatosplenomegaly Weakened peripheral pulses, edema, and cyanosis Lab tests The following laboratory studies may be performed in patients with suspected pericardial effusion: Electrolyte levels CBC count with differential Cardiac biomarker levels (eg, troponin, CK-MB, LDH) Tests for other markers of inflammation (eg, ESR, CRP) TSH level Blood cultures RF (...) Pericardial Effusion (Diagnosis) Pericardial Effusion: Practice Essentials, Background, Pathophysiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTU3MzI1LW92ZXJ2aWV3 processing > Pericardial Effusion Updated

2014 eMedicine.com

6. Pericardial Effusion (Overview)

friction rub Tachycardia Hepatojugular reflux Tachypnea Decreased breath sounds Ewart sign: Dullness to percussion beneath the angle of left scapula Hepatosplenomegaly Weakened peripheral pulses, edema, and cyanosis Lab tests The following laboratory studies may be performed in patients with suspected pericardial effusion: Electrolyte levels CBC count with differential Cardiac biomarker levels (eg, troponin, CK-MB, LDH) Tests for other markers of inflammation (eg, ESR, CRP) TSH level Blood cultures RF (...) Pericardial Effusion (Overview) Pericardial Effusion: Practice Essentials, Background, Pathophysiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTU3MzI1LW92ZXJ2aWV3 processing > Pericardial Effusion Updated

2014 eMedicine.com

7. Myocarditis

[Citation ends]. History and exam presence of risk factors viral syndrome (prior) autoimmune disease infectious disease drugs and toxins age <50 years chest pain dyspnoea orthopnoea fatigue palpitations rales elevated neck veins S3 gallop sinus tachycardia atrial and ventricular arrhythmias syncope S3 and S4 summation gallop pericardial friction rub peripheral hypoperfusion hypotension altered sensorium lymphadenopathy infection (non-HIV) HIV infection smallpox vaccination autoimmune/immune-mediated

2018 BMJ Best Practice

8. Pericarditis

Pericarditis Pericarditis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Pericarditis Last reviewed: February 2019 Last updated: December 2018 Summary Symptoms include sharp, severe retrosternal chest pain worse with inspiration and a supine position. The classic physical finding is a pericardial friction rub. A low-grade fever is often present. Diagnostic signs include diffuse electrocardiographic ST elevations (...) . It can be either fibrinous (dry) or effusive with a purulent, serous, or haemorrhagic exudate. It is characterised clinically by a triad of chest pain, pericardial friction rub, and serial electrocardiographic changes. Constrictive pericarditis impedes normal diastolic filling and can be a medium to late complication of acute pericarditis. Pericarditis is the most common disease of the pericardium encountered in clinical practice. History and exam presence of risk factors chest pain pericardial rub

2018 BMJ Best Practice

9. Pericarditis

Pericarditis Pericarditis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Pericarditis Last reviewed: February 2019 Last updated: December 2018 Summary Symptoms include sharp, severe retrosternal chest pain worse with inspiration and a supine position. The classic physical finding is a pericardial friction rub. A low-grade fever is often present. Diagnostic signs include diffuse electrocardiographic ST elevations (...) . It can be either fibrinous (dry) or effusive with a purulent, serous, or haemorrhagic exudate. It is characterised clinically by a triad of chest pain, pericardial friction rub, and serial electrocardiographic changes. Constrictive pericarditis impedes normal diastolic filling and can be a medium to late complication of acute pericarditis. Pericarditis is the most common disease of the pericardium encountered in clinical practice. History and exam presence of risk factors chest pain pericardial rub

2018 BMJ Best Practice

13. You Diagnose Pericarditis at your Peril (at the Patient's Peril!)

is typically positional ( worse in supine position ) and pleuritic ( aggravated by deep inspiration ). Although a pericardial friction rub is not always present — it should always be carefully listened for, because if you do hear a rub in the right clinical setting — then you have made the diagnosis. Why then in the literally hundreds of suspected cases that I’ve seen ECGs posted on the internet in recent years with a query about pericarditis — is it so very rare for anyone to ever describe the nature (...) that of pericarditis. If that were the differential diagnosis, then pericarditis would be a reasonable thought, and one should look for PR depression (not present), STE in II greater than III (which is present), Spodick's sign (downsloping TP segment - to my knowledge this has never been verified as a true sign of pericarditis), as well as clinical factors such as a rub or effusion. However, in almost every case, one should confirm absence of OMI (Occlusion MI) at least by contrast ultrasound. But absence of ST

2018 Dr Smith's ECG Blog

14. Chest pain

murmur (aortic value regurgitation); and occasionally a pericardial friction rub. Neurological deficits may be present (such as hemiplegia). Pericarditis/cardiac tamponade Symptoms — sharp, constant sternal pain relieved by sitting forward. Pain may radiate to the left shoulder and/or left arm into the abdomen, and is worse when lying on the left side and on inspiration, swallowing, and coughing. Other symptoms may include fever, cough, and arthralgia. A cardiac tamponade may have associated (...) breathlessness, dysphagia, cough, and hoarseness. Signs — pericardial friction rub (high pitched scratching sound, best heard over the left sternal border during expiration). Signs of a cardiac tamponade include pulsus paradoxus (decrease in palpable pulse and arterial systolic blood pressure of 10 mmHg on inspiration); and hypotension, muffled heart sounds, and jugular venous distention (Beck's Triad). Acute congestive cardiac failure Symptoms — ankle swelling, tiredness, severe breathlessness, orthopnea

2017 NICE Clinical Knowledge Summaries

15. 2014 AHA/ACC Guideline for the Management of Patients With Non?ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

with chest pain, several of which are life threatening. Aortic dissection is suggested by back pain, unequal palpated pulse volume, a difference of =15 mm Hg between both arms in systolic blood pressure (BP), or a murmur of aortic regurgitation. Acute pericarditis is suggested by a pericardial friction rub. Cardiac tamponade can be reflected by pulsus paradoxus. Pneumothorax is suspected when acute dyspnea, pleuritic chest pain, and differential breath sounds are present. A pleural friction rub may (...) for the diagnosis of MI. 3.2.5. Imaging A chest roentgenogram is useful to identify potential pulmonary causes of chest pain and may show a widened mediastinum in patients with aortic dissection. Computed tomography (CT) of the chest with intravenous contrast can help exclude pulmonary embolism and aortic dissection. Transthoracic echocardiography can identify a pericardial effusion and tamponade physiology and may also be useful to detect regional wall motion abnormalities. Transesophageal echocardiography can

2014 Society for Cardiovascular Angiography and Interventions

16. Non-ST-Elevation Acute Coronary Syndromes: Guideline For the Management of Patients With

- ACS. The physical examination can indicate alternative diagnosesinpatientswithchestpain,severalofwhichare life threatening. Aortic dissection is suggested by back pain, unequal palpated pulse volume, a difference of$15 mmHgbetweenbotharmsinsystolicbloodpressure(BP), or a murmur of aortic regurgitation. Acute pericarditis is suggested by a pericardial friction rub. Cardiac tampo- nade can be re?ected by pulsus paradoxus. Pneumo- thorax is suspected when acute dyspnea, pleuritic chest pain (...) ,anddifferentialbreathsoundsarepresent.Apleural friction rub may indicate pneumonitis or pleuritis. 3.2.3. Electrocardiogram A12-leadECGshouldbeperformedandinterpretedwithin 10minutesofthepatient’sarrivalatanemergencyfacility to assess for cardiac ischemia or injury (21).Changeson ECG in patients with NSTE-ACS include ST depression, transient ST-elevation, or new T-wave inversion (21,58). Persistent ST-elevation or anterior ST depression indica- tiveoftrueposteriorMIshouldbetreatedaccordingtothe STEMI CPG (17). The ECG can be relatively

2014 American College of Cardiology

17. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes Full Text available with Trip Pro

can indicate alternative diagnoses in patients with chest pain, several of which are life threatening. Aortic dissection is suggested by back pain, unequal palpated pulse volume, a difference of ≥15 mm Hg between both arms in systolic blood pressure (BP), or a murmur of aortic regurgitation. Acute pericarditis is suggested by a pericardial friction rub. Cardiac tamponade can be reflected by pulsus paradoxus. Pneumothorax is suspected when acute dyspnea, pleuritic chest pain, and differential (...) breath sounds are present. A pleural friction rub may indicate pneumonitis or pleuritis. 3.2.3. Electrocardiogram A 12-lead ECG should be performed and interpreted within 10 minutes of the patient’s arrival at an emergency facility to assess for cardiac ischemia or injury. Changes on ECG in patients with NSTE-ACS include ST depression, transient ST-elevation, or new T-wave inversion. , Persistent ST-elevation or anterior ST depression indicative of true posterior MI should be treated according

2014 American Heart Association

19. Tropical Travel Trouble 005 RUQ Pain and Jaundice

. This can result in pneumonia, pneumonitis, lung abscess, and bronchohepatic fistula formation. Patients often have acute development of right chest pain, cough, and expectoration of large volumes of dark brown fluid. Pericardial Amoebiasis occurs in less than 1% of amoebic liver abscesses, but is more common if the left lobe is affected. There is often a precursor stage where a sterile pericardial effusion forms (a friction rub might be appreciated), but invasion of the abscess into the pericardium (...) commonly results in tamponade and death in ~40% of patients. Subsequent loculations are common, necessitating open drainage of the pericardial sac. Cerebral amoebiasis has been described in less than 0.1% of patients in large clinical series, but has been documented in up to 2.5% of patients who have amoebiasis at autopsy. Although the symptoms of cerebral involvement depend on the lesion, reports often show abrupt onset of symptoms and death within 12–72 hours if treatment is delayed or indequate

2018 Life in the Fast Lane Blog

20. The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease

? pericardial friction rub or effusion • Expanded discussion on cognitive dysfunction with chorea • Upper limits of normal (ULN) for serum streptococcal antibody titres expanded to include children and adults based on Fiji data (Table 3.6) Table 1.1 Levels of evidence for clinical interventions, and grades of recommendation Level of evidence Study design Grade of recommendation I Evidence obtained from a systematic review of all relevant RCT A Rich body of high quality RCT data II Evidence obtained from

2012 Clinical Practice Guidelines Portal

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