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Manipulative Augmentation of Pericardial Rubs

Arthur J. Geiger, M.D.
JAMA. 1961;176(12):1053. doi:10.1001/jama.1961.03040250079027.
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To the Editor:—  For more than 2 decades I have been teaching and demonstrating 2 simple maneuvers that frequently elicit or augment the diagnostic friction sounds of pericarditis of various etiologies.One maneuver is merely an extension of the well-known practice of having the patient lean forward; it is to place the patient in the knee-elbow or prone position during ausculation. Thus, an inaudible or merely suggestive pericardial rub often becomes intensified, probably by bringing about a closer and firmer contact between the epicardium, pericardium, and chest wall.Another even simpler and more practical maneuver is to listen for the rub while the patient takes and holds a moderately deep breath. This is contrary to traditional teaching in physical diagnosis, in which auscultation during held expiration is conventionally advised. It has been possible on scores of occasions to demonstrate unequivocally that an otherwise inaudible or faint or single-phase rub (that


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