How to differentiate pericardial friction sound from pleural friction sound

Many people cannot correctly distinguish between a pericardial friction rub and a pleural friction rub. In fact, pericardial friction sound is a disease caused by pericarditis. When this disease occurs, the patient will experience pain in the precordial area and behind the sternum, and the pain will also spread to other parts. Some people with pericardial friction rubs may experience difficulty breathing, coughing, and difficulty swallowing food. Pleural friction rubs do not cause these symptoms.

Common methods for distinguishing pericardial friction rub from pleural friction rub :

A pericardial friction rub is usually a brief, scratching, rubbing, or crunching sound caused by the inflamed pericardial layers rubbing against each other. This sound is most noticeable at the left edge of the sternum and during deep inspiration. A pericardial friction rub suggests pericarditis, which may be caused by acute infection, heart failure, or renal insufficiency. Treatment may include pericardiocentesis to prevent cardiogenic shock. Treat underlying causes with anti-inflammatory agents, antiarrhythmic drugs, diuretics, or antibiotics. If necessary, perform pericardiotomy.

If the patient shows signs of pallor, decreased skin temperature, cool and clammy skin, hypotension, tachycardia, tachypnea, pulsus paradoxus, and increased distension of the internal jugular vein, preparations should be made for pericardiocentesis to prevent cardiogenic shock. Make sure the patient gets enough rest. Treat underlying causes with anti-inflammatory agents, antiarrhythmic drugs, diuretics, or antibiotics. If necessary, a pericardiotomy is performed to allow adequate cardiac filling and contraction.

Pleural friction sound : When the pleural surface becomes rough due to inflammation, a friction sound between the visceral pleura and the parietal pleura may occur with breathing, which is called pleural friction sound. The nature of sounds varies greatly, some are soft and subtle, while others are very rough. Both inhalation and exhalation can be heard. It is usually more obvious before inhalation and at the beginning of exhalation. The sound disappears if you hold your breath and becomes stronger when you take a deep breath. It can be used to distinguish it from the pericardial friction sound. Ask the patient to cover his nose and mouth and increase abdominal exercises. At this time, although there is no airflow in and out of the airway, pleural friction sound can still be heard, which can be distinguished from crackling sound. The most common site for pleural friction sound is the anterior and inferior chest wall because this area has the greatest respiratory movement. It is common in diseases such as fibrinous pleurisy, pulmonary infarction, uremia, pleural tumors, small amounts of pleural effusion, and severe dehydration.