Pericardial friction murmur


 * occurrence: in pericarditis or in the first few days after open heart surgery (so-called "postpericardiotomy syndrome")
 * is caused by shifting and rubbing of inflammatory-altered pericardial leaves during heart movements
 * characteristics: rough, scratchy, may resemble the crunch of frozen snow under the shoe
 * audible anywhere on the chest, amplifies when the stethoscope is pressed
 * listening maximum: along the edge of the sternum
 * changes with position - more audible in forward bend and sitting position

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 * systolic functional murmurs: vibrating murmur (Still), pulmonary expulsive murmur, supraclavicular murmur
 * continuous functional murmurs: whirling venous murmur