Which physical finding is characteristic of acute pericarditis?

• A. Lower extremity edema
• B. Carotid bruit
• C. Pericardial friction rub
• D. Splinter hemorrhages

Answer: (C)

Pericardial friction rub is the hallmark physical finding in acute pericarditis. It happens when the inflamed pericardial surfaces rub against each other during the cardiac cycle. The sound is scratchy and high-pitched and is best heard at the left lower sternal border with the patient leaning forward. This auscultatory sign directly reflects the inflammatory process entering the pericardial space.

The other options don’t fit acute pericarditis: lower-extremity edema suggests venous congestion or heart failure; a carotid bruit points to carotid artery disease; splinter hemorrhages are associated with endocarditis or microembolization. In the appropriate clinical context, acute pericarditis may also present with chest pain relieved by sitting up and leaning forward and with diffuse ECG changes, but the friction rub on examination is the classic physical finding.