ORIGINAL ARTICLE
Friction and fluid: correlating pericardial effusion and pericardial friction rub
S. Natan, E.J.P. Lamfers, A.J.M. Oude Ophuis, B.T.J. Meursing
Background. In this study the relationship between pericardial friction rub (PFR) and the degree of pericardial effiusion was investigated. Methods. A retrospective study was perfonned involving all patients for whom the diagnosis pericarditis was made on cfinical grounds (type of chest pain, fever, laboratory findings and/or electrocardiographic signs) in the period 19901999. In this patient group (n=138) the presence of PFRwas correlated against the amount of pericardial eff-usion measured echocardiographically. Results. No statistically significant correlation between the presence of PFR and the amount of pericardial effusion was observed. It is, therefore, a misconception that the presence of a PFRsignifies absence or only a small volume of pericardial eff-usion. Our results are in line with the literature. Conclusion. Based on this study and results presented in the literature, we postulate that the friction rub associated with pericarditis is not caused by friction of the 'roughened' pericardial layers, as is commonly propagated. Instead fibrin strands caused by the inflammation, connecting the two pericardial layers, may function as snares and generate, through the movements of the heart, the typical triphasic pericardial friction rub. (Neth HeartJ2001;9:123-6.)
A mong other protective and mechanical functions, the pericardium serves as a barrier against infectious processes. It consists of two layers: a fibrous outer (parietal) layer and a serous inner (visceral) layer. Normally, these layers are separated by about 50 ml fluid, which is an ultrafiltrate of plasma.1 In conditions such as infection, metastatic disease) acute myocardial infarction or post cardiac surgery a PFR, which is typically triphasic, may be heard. More fluid then sometimes accumulates in the pericardial space. It is a common belief that PFR is the result of friction between the two 'roughened' pericardial layers.2'3 Many physicians therefore tend to think that PFR cannot be heard in the presence of a large pericardial effusion because the pericardial layers are then widely separated. In this study we investigated the relationship between PFR and the degree of pericardial effusion.
Address for correspondence: B.T.J. Meursing. E-mail: [email protected]
Methods Between the 1st of January 1991 and the 31st of December 1999, pericarditis was diagnosed in 154 patients at the Department of Cardiology of the Canisius-Wilhelmina Hospital. Diagnosis was based on a combination of clinical grounds (characteristic chest pain, fever, laboratory findings and/or electrocardiographic signs). Laboratory findings were an elevated sedimentation rate and/or CRP, while electrocardiographic signs considered to be characteristic were the typical stage 12 ST-segment elevation in all leads except aVRand V1. Only patients showing at least one documentation of PFR, positive or negative, in the medical records during hospitalisation were included in the study. Patients lacking echocardiographic information in the acute phase were excluded. The remaining 138 patients (106 male; mean age: 55 years) were divided into three groups according to the amount of pericardial effusion (PE) detected by echocardiography. Using the two-dimensional mode (parasternal long-axis view, apical four-chamber view and subcostal view) the maximum distance between the epicardium and the myocardium was measured end-diastolically. The following groups were defined:
Netherlands Heart Joumal, Volume 9, Number 3, June 2001
123
Keywords: pericardial effusion, pericardial friction rub
S. Natan. E.J.P. Lamfers. AJ.M. Oude Ophuls. B.T.J. Moursing.
Canisius-WilheImina Hospital, P0 Box 9015, 6500 GS
Nijmegen.
Friction and fluid: correlating pericardial effusion and pericardial friction rub
Large effusion PE >10 mm; Moderate effusion PE >1mm and
Friction and fluid: correlating pericardial effusion and pericardial friction rub
S. Natan, E.J.P. Lamfers, A.J.M. Oude Ophuis, B.T.J. Meursing
Background. In this study the relationship between pericardial friction rub (PFR) and the degree of pericardial effiusion was investigated. Methods. A retrospective study was perfonned involving all patients for whom the diagnosis pericarditis was made on cfinical grounds (type of chest pain, fever, laboratory findings and/or electrocardiographic signs) in the period 19901999. In this patient group (n=138) the presence of PFRwas correlated against the amount of pericardial eff-usion measured echocardiographically. Results. No statistically significant correlation between the presence of PFR and the amount of pericardial effusion was observed. It is, therefore, a misconception that the presence of a PFRsignifies absence or only a small volume of pericardial eff-usion. Our results are in line with the literature. Conclusion. Based on this study and results presented in the literature, we postulate that the friction rub associated with pericarditis is not caused by friction of the 'roughened' pericardial layers, as is commonly propagated. Instead fibrin strands caused by the inflammation, connecting the two pericardial layers, may function as snares and generate, through the movements of the heart, the typical triphasic pericardial friction rub. (Neth HeartJ2001;9:123-6.)
A mong other protective and mechanical functions, the pericardium serves as a barrier against infectious processes. It consists of two layers: a fibrous outer (parietal) layer and a serous inner (visceral) layer. Normally, these layers are separated by about 50 ml fluid, which is an ultrafiltrate of plasma.1 In conditions such as infection, metastatic disease) acute myocardial infarction or post cardiac surgery a PFR, which is typically triphasic, may be heard. More fluid then sometimes accumulates in the pericardial space. It is a common belief that PFR is the result of friction between the two 'roughened' pericardial layers.2'3 Many physicians therefore tend to think that PFR cannot be heard in the presence of a large pericardial effusion because the pericardial layers are then widely separated. In this study we investigated the relationship between PFR and the degree of pericardial effusion.
Address for correspondence: B.T.J. Meursing. E-mail: [email protected]
Methods Between the 1st of January 1991 and the 31st of December 1999, pericarditis was diagnosed in 154 patients at the Department of Cardiology of the Canisius-Wilhelmina Hospital. Diagnosis was based on a combination of clinical grounds (characteristic chest pain, fever, laboratory findings and/or electrocardiographic signs). Laboratory findings were an elevated sedimentation rate and/or CRP, while electrocardiographic signs considered to be characteristic were the typical stage 12 ST-segment elevation in all leads except aVRand V1. Only patients showing at least one documentation of PFR, positive or negative, in the medical records during hospitalisation were included in the study. Patients lacking echocardiographic information in the acute phase were excluded. The remaining 138 patients (106 male; mean age: 55 years) were divided into three groups according to the amount of pericardial effusion (PE) detected by echocardiography. Using the two-dimensional mode (parasternal long-axis view, apical four-chamber view and subcostal view) the maximum distance between the epicardium and the myocardium was measured end-diastolically. The following groups were defined:
Netherlands Heart Joumal, Volume 9, Number 3, June 2001
123
Keywords: pericardial effusion, pericardial friction rub
S. Natan. E.J.P. Lamfers. AJ.M. Oude Ophuls. B.T.J. Moursing.
Canisius-WilheImina Hospital, P0 Box 9015, 6500 GS
Nijmegen.
Friction and fluid: correlating pericardial effusion and pericardial friction rub
Large effusion PE >10 mm; Moderate effusion PE >1mm and
