Pericarditis

1. What is the mechanism that causes friction rubs?

ANS: It is usually assumed that the rub sounds are caused by the two roughened pericardial membranes (the visceral and parietal pericardia) sliding over each other. However, when the overlying pleura is also involved, perhaps the noises are caused by the pleura rubbing against the outer layer of pericardium. The rub then would be a pleuropericardial friction rub.

This murmur of primary PR in a teen-age boy was early diastolic and had many low and medium frequencies in it. It did not increase with inspiration at the second left interspace because too much air was interposed between heart and stethoscope in that area. The murmur was softer at the left lower sternal border, where, however, it did become louder with inspiration.

This murmur of primary PR in a teen-age boy was early diastolic and had many low and medium frequencies in it. It did not increase with inspiration at the second left interspace because too much air was interposed between heart and stethoscope in that area. The murmur was softer at the left lower sternal border, where, however, it did become louder with inspiration.

Note: The three most common causes of generalized pericarditis are viral pericarditis, disseminated lupus, and uremia.

2. What is the most common cause of a localized pericarditis?

ANS: Acute myocardial infarction.

Note: a. If there has been neither infarction nor trauma to the heart (including radiation to the chest), then consider a metastatic tumor involving the heart.

b. Inability to extend the neck is common in pericarditis. Patients may lie prone and flexed on their pillows.

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