12 Clinical Examination A comprehensive clinical examination is imperative in the assessment of this patient population and should include assessment for features of: Inflammatory pericarditis Cardiac tamponade Causative etiologies Potential alternative diagnoses Inflammatory pericarditis assessment A triphasic pericardial friction rub, arising due to friction between the inflamed pericardial layers during cardiac motion, is pathognomonic of inflammatory pericarditis and is a key diagnostic characteristic of this condition. This is typically described as a grating, scratching sound that is heard best at the left sternal border and louder during inspiration. Although its specificity approaches 100%, its sensitivity is significantly less, occurring in approximately a third of patients with inflammatory pericarditis.36 Common findings also include sinus tachycardia and a lowgrade fever, although a fever >38ºC can be seen in severe inflammatory pericarditis or purulent bacterial pericarditis. Cardiac tamponade assessment Patients presenting with inflammatory pericarditis should be carefully assessed for features of cardiac tamponade complicating pericardial inflammation. It should be remembered that the diagnosis of cardiac tamponade is a clinical diagnosis, rather than one made by imaging. Examination should include assessment for: tachycardia, hypotension, pulsus paradoxus (>10mm Hg decrease in systolic blood pressure with inspiration), jugular venous distention and muffled heart sounds. Causative etiologies assessment Clinical examination should include assessment for potential causative etiologies of pericarditis based on the clinical history obtained. This should include a routine comprehensive rheumatologic examination in this patient population to carefully assess for potential autoimmune causes of pericarditis. Potential alternative diagnoses assessment Examination should include careful assessment of potential alternative diagnoses that may masquerade as pericarditis, including palpation of the anterior chest wall looking for musculoskeletal tenderness and eliciting epigastric tenderness as a marker for gastritis.
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