During a patient's cardiovascular evaluation, you detect a high-pitched, scratchy, scraping cardiac sound that is synchronous with the heartbeat while using the diaphragm of the stethoscope. The sound is heard best when the patient leans forward and holds their breath after expiration. Which potential finding is most accurately described by these characteristics?
The correct answer is pericardial friction rub. This sound occurs when the inflamed layers of the pericardium rub against one another. It is typically high-pitched and scratchy and becomes easier to hear when the patient leans forward and exhales fully, bringing the heart closer to the chest wall. Mitral valve prolapse usually produces a mid-systolic click followed by a late systolic murmur. An aortic ejection click is an early systolic sound heard immediately after S1 and is not scratchy or scraping. A third heart sound (S3) is a low-frequency sound commonly associated with heart failure and is not described as high-pitched or scratchy.
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