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The physical examination found disseminated bronchial rales, no pleural friction rub, normal hemodynamic parameters (heart rate 84 beats per minute, blood pressure of 110/70 mmHg), varicose veins of left lower limb.
A pain of pericarditis, new onset murmur, pericardial friction rub and heart failure symptoms can be observed as initial ARF symptoms.
At this level of fluid accumulation the therapist will often hear diminished breath sounds, with dullness to percussion, as well as reduced tactile and vocal fremitus and occasionally a pleural friction rub if inflammation is present.