Summary about Disease
A friction rub is a coarse, grating, or scratching sound heard on auscultation (listening with a stethoscope). It is produced when inflamed surfaces of the pericardium (pericardial friction rub) or pleura (pleural friction rub) rub together. It indicates inflammation of these membranes. Less commonly, it can occur in the abdomen (abdominal friction rub). This information focuses primarily on pericardial and pleural friction rubs.
Symptoms
The symptoms depend on the underlying condition causing the friction rub. Symptoms may include:
Pericardial friction rub: Chest pain (sharp, stabbing, or dull), often worse with deep breathing, coughing, or lying down. Fever, fatigue, and shortness of breath may also be present.
Pleural friction rub: Chest pain that is often sharp and stabbing, usually worse with breathing or coughing. Shortness of breath may also be present.
Causes
Pericardial friction rub: Pericarditis (inflammation of the pericardium) caused by viral infections, bacterial infections, fungal infections, autoimmune diseases (lupus, rheumatoid arthritis), uremia (kidney failure), post-myocardial infarction (Dressler's syndrome), cancer, trauma, or certain medications.
Pleural friction rub: Pleurisy (inflammation of the pleura) caused by viral infections, bacterial infections (pneumonia), pulmonary embolism, autoimmune diseases (lupus, rheumatoid arthritis), cancer, trauma, or asbestos exposure.
Medicine Used
Medications depend on the underlying cause of the friction rub:
Pericardial friction rub:
NSAIDs (Ibuprofen, Aspirin): To reduce inflammation and pain.
Colchicine: To reduce inflammation and prevent recurrence.
Corticosteroids (Prednisone): In severe cases or when NSAIDs and colchicine are ineffective.
Antibiotics or antifungals: If the cause is bacterial or fungal.
Diuretics: To reduce fluid build up.
Pleural friction rub:
NSAIDs (Ibuprofen, Aspirin): To reduce inflammation and pain.
Antibiotics: If the cause is a bacterial infection (pneumonia).
Pain relievers: To manage pain.
Is Communicable
The friction rub itself is not communicable. However, if the underlying cause is an infectious disease (e.g., viral or bacterial infection), then the underlying infection may be communicable.
Precautions
Precautions depend on the underlying cause. If the cause is infectious:
Good hand hygiene: Frequent handwashing with soap and water.
Respiratory hygiene: Covering coughs and sneezes.
Avoiding close contact: With individuals who are sick.
How long does an outbreak last?
The duration depends entirely on the underlying condition causing the friction rub.
Pericarditis/Pleurisy due to viral infection: May resolve within 1-3 weeks with treatment.
Pericarditis/Pleurisy due to autoimmune conditions or other chronic diseases: May be longer-lasting, requiring ongoing management.
How is it diagnosed?
Diagnosis involves:
Auscultation: Listening to the chest with a stethoscope to identify the friction rub sound.
Medical history and physical examination: To assess symptoms and potential underlying causes.
Diagnostic tests:
Electrocardiogram (ECG/EKG): To detect heart abnormalities (pericarditis).
Chest X-ray: To identify lung abnormalities (pleurisy, pneumonia).
Echocardiogram: To assess heart function (pericarditis).
Blood tests: To check for infection, inflammation, or kidney problems.
CT scan or MRI: May be needed for further evaluation.
Pericardiocentesis: Removing and analyzing fluid from the pericardial sac (pericarditis).
Thoracentesis: Removing and analyzing fluid from the pleural space (pleurisy).
Timeline of Symptoms
The timeline of symptoms varies depending on the underlying cause:
Acute infection: Symptoms may develop rapidly over a few days.
Autoimmune disease: Symptoms may develop gradually over weeks or months.
Post-MI (Dressler's syndrome): Symptoms may appear weeks or months after a heart attack.
Important Considerations
A friction rub is a sign of inflammation and should be evaluated by a healthcare professional to determine the underlying cause.
Early diagnosis and treatment are important to prevent complications such as cardiac tamponade (pericardial friction rub) or empyema (pleural friction rub).
Treatment focuses on addressing the underlying cause and managing symptoms.
It is important to follow the healthcare provider's recommendations for medications, lifestyle modifications, and follow-up appointments.