What is a hallmark finding in pericarditis?

• A. A pericardial friction rub and fluid accumulation in the pericardial sac.
• B. A loud S1 heart sound with normal pericardial fluid.
• C. A murmur best heard at the apex.
• D. Elevated blood pressure with tachycardia.

Answer: (A)

Pericarditis is marked by inflammation of the pericardial linings, and the key bedside finding is a pericardial friction rub. This scratchy, high-pitched sound is caused by the inflamed visceral and parietal pericardial layers rubbing against each other as the heart moves, most easily heard with the patient leaning forward and the stethoscope at the left lower sternal border during respiration. The rub can be present with or without a concurrent pericardial effusion, which is fluid accumulation in the sac. Therefore, the combination of a pericardial friction rub and potential fluid buildup best captures the typical exam findings in pericarditis. Other choices describe signs not characteristic of pericarditis, such as an abnormal S1, a murmur at the apex, or hypertension with tachycardia, which do not define this condition.