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This recording is from a patient taken in the early postoperative period following the repair of atrial septal defect. Patient had some precordial chest discomfort aggravated by movement of the chest as well as by inspiration. Describe the findings on auscultation and what do they suggest about the cause of the discomfort? One can hear a scratchy noise (like a murmur) which however seems to have a changing intensity in systole and diastole. It seems to have three parts one systolic and two diastolic parts. The first part in diastole appears to follow the S2 and the second part in diastole seems to occur before the systolic part. One cannot clearly hear the S1. The rhythm is somewhat like this: Shoo Shoooo Shooo…..Shoo Shoooo Shooo…..This is most likely a pericardial friction rub and is probably due to the post-operative pericarditis, which must account for the chest discomfort of the patient. Intermittently it also seems to wax and wane perhaps being intensified by inspiration, which is also quite characteristic of pericardial friction rub.