Pericardial rub

Specialty: Cardiovascular.

• pericardial rub
• pericardial friction rub

Why it occurs

• Acute idiopathic or viral pericarditis
• Uremic pericarditis (secondary to end-stage chronic renal failure)
• Acute transmural myocardial infarction (friction from early epistenocarditis or late Dressler syndrome)
• Bacterial or tuberculous pericarditis
• Pericardial involvement due to connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis)
• Post-pericardiotomy or cardiac trauma

Initial workup

Continuous or 12-lead electrocardiogram to identify diffuse elevation of the ST segment with superior concavity and low level of the PR segment; High-sensitivity serum troponin I or T determination to rule out myopericarditis or acute myocardial infarction; Transthoracic echocardiogram to verify the presence, location and volume of pericardial fluid, as well as evaluate signs of hemodynamic compromise (cavity collapse); General blood analysis that includes urea, creatinine, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

Standard management

• Ibuprofen — non-steroidal anti-inflammatory drug of choice in idiopathic or viral pericarditis; 600 mg every 8 hours orally for 1 to 2 weeks, with subsequent gradual tapering and gastric protection
• Colchicine — adjuvant drug to prevent recurrences of pericarditis; 0.5 mg once daily for weight <70 kg or twice daily for weight >=70 kg orally for 3 months
• Acetylsalicylic acid — of choice in case of post-myocardial infarction pericarditis; 500 to 1000 mg every 6 to 8 hours orally, avoiding other NSAIDs due to the risk of free wall rupture or poor healing
• Prednisone (glucocorticoid reserved for refractory cases, with documented autoimmune etiology or contraindication to NSAIDs; 0.2 to 0.5 mg/kg/day orally, with extremely slow tapering pattern).