What is a typical physical examination finding in acute pericarditis?

• A. Fever with rigors
• B. Friction rub
• C. Murmur at apex
• D. S3

Answer: (B)

The main concept here is recognizing a physical sign that points to inflammation of the pericardium. In acute pericarditis, you often hear a pericardial friction rub—a scratchy, high-pitched sound produced by inflamed pericardial surfaces sliding against each other. It’s classically heard best at the left lower sternal border when the patient leans forward and during expiration, and it can be triphasic, reflecting motion of the heart during atrial systole, ventricular systole, and early diastole. The rub may wax and wane with changes in position or with the evolution of the inflammatory process, which makes it a helpful diagnostic clue when present.

Fever with rigors points more toward a systemic infection with chills, which isn’t the characteristic acoustic finding of pericarditis. A murmur at the apex would suggest a valvular problem such as mitral regurgitation, not pericardial inflammation. An S3 is associated with volume overload and heart failure rather than pericardial inflammation.