In acute pericarditis, which auscultatory finding may be present?

• A. Murmur
• B. Pericardial friction rub
• C. S3 heart sound
• D. Normal auscultation

Answer: (B)

Inflammation of the pericardial sac can produce a friction rub heard on auscultation. In acute pericarditis, this friction rub is the classic auscultatory finding. It’s a scratchy, high-pitched sound best heard with the patient leaning forward, at the left lower sternal border, and often more noticeable during expiration. The sound can be triphasic, reflecting the inflamed surfaces rubbing against each other during systole and diastole.

Murmurs arise from valvular disease, not pericardial inflammation, so they aren’t characteristic of acute pericarditis. An S3 heart sound indicates volume overload or systolic dysfunction rather than pericardial irritation. And while a friction rub isn’t always present in every patient with acute pericarditis, normal auscultation would not be the expected finding in the setting of this inflammatory process.