Heart Sounds Tutorial

Table of Contents

1. Introduction
2. The Basics
3. Murmurs
4. Extracardiac Sounds
   1. Pericardial Rub
   2. Mediastinal crunch
5. MCQ
6. Acknowledgements and References

Pericardial Rub

A Pericardial Rub or Pericardial Friction Rub is caused by inflammation of the pericardial sac either with or without fluid being present.

High pitched and scratchy in nature, akin to the noise sandpaper makes (when used). For completeness sake a pleural rub sounds more like walking on snow.

By bringing the heart closer to the chest wall it is easier to auscultate these sounds

1

Observing the statement above, how would it be best to bring the heart to the chest wall? Would you have the patient... a) ... inhale deeply and hold their breath b) ... exhale forcefully and hold their breath c) ... positioned lying down flat d) ... positioned sitting up and leaning forward e) .... positioned lying down at 45 degrees Correct you want the patient leaning forward holding their breath on forced expiration to accentuate this murmurNo, you want the patient leaning forward holding their breath on forced expiration to accentuate this murmur as it brings the heart closer to the chest wallYour answer has been saved.

There are 3 points in the cardiac cycle when the heart can produce a pericardial friction rub these are

• Ventricular Contraction
• Atrial Contraction
• Rapid early diastolic filling

The following is a short sound of a pericardial rub, listen and compare this to a normal heart sound.