For my students

1. The Pericardium
M. Nadeem Khan
AKTC, AMU, Aligarh

2. Pericardium:
(Peri-around, Cardium-heart)
 It is a double-walled, fluid filled sac.
 It contains the heart and the juxtacardiac parts of its great vessels
(The aorta, the vena cava and the pulmonary artery).

3. Pericardium
Inner Serous
layer
Inner
visceral
Outer
Parietal
Outer
Fibrous layer
Single Layer

5. FIBROUS PERICARDIUM:
 The fibrous pericardium is a sac made of tough connective tissue
 It is roughly conical and clothes the heart.
Attachments:
 Superiorly, it is continuous with the adventitia of the great vessels
and also the pre-tracheal fascia.
 Inferiorly, it is attached the the central tendon of the diaphragm.

6.  Anteriorly, it is attached to the posterior surface of the sternum
by superior and inferior sterno-pericardial ligaments. The
extents of these ligaments are extremely variable and the
superior one is often undetectable.
 The pericardium is securely anchored by these attachments
and maintains the general thoracic position of the heart,
serving as the ‘cardiac seat belt’.

7. Relations:
Anteriorly:
 Separated from the thoracic wall by the lungs and the pleural
coverings.
 But, in a small area behind the lower left half of the body of the
sternum and the sternal ends of the left 4th and 5th costal
cartilages , the pericardium is in direct contact with the thoracic
wall.
 Until it regresses, the lower end of the thymus is anterior to the
upper part.

8. Posteriorly,
 The principal bronchi, the esophagus, the
esophageal plexus, the descending thoracic aorta,
and the posterior parts of the mediastinal surface
of both lungs.
Laterally,
 Pleural coverings of the mediastinal surface of the
lungs.
 The phrenic nerve with its accompaning vessels,
descends between the mediastinal pleura and the
fibrous pericardium on either side.

9. Inferiorly,
 The pericardium is separated from the liver and the fundus of
stomach by the diaphragm.

10. SEROSAL PERICARDIUM:
It is a closed sac within the fibrous pericardium and has a visceral
and a parietal layer.
The visceral layer or the epicardium covers the heart and the great
vessels and is reflected into the parietal layer which lines the inner
surface of the fibrous pericardium.

11. SEROSAL PERICARDIUM:
The reflections of the serosal layer are arranged as two complex
tubes : the aorta and the pulmonary trunk are enclosed in one and
the superior and inferior vena cavae and the pulmonary veins in the
other.

12.  The tube surrounding the veins has an inverted J shape.
 The cul-de-sac within its curve is behind the left atrium
and is termed the ‘OBLIQUE SINUS’.
The passage between the two pericardial tubes is termed the
‘TRANSVERSE SINUS’.

16. Blood supply:
• Blood is derived from the internal thoracic, The musculophrenic
arteries and the descending thoracic aorta.
• The veins are tributaries of the azygous system.
Innervation:
The pericardium is innervated by the vagus, together with the phrenic
nerves and the sympathetic trunks

17. Functions of the pericardium:
 Keeps the heart contained in the thoracic cavity(cardiac seat belt).
 Prevents over-expanding of heart when blood volume increases.
 Limits the heart’s movements.
 Acts as a shock absorber with the help of the fluid filled sac.

18. Applied aspects:
Pericardial effusion:
• Accumulation of excess fluid in the pericardial space.
• When this obstructs the beating of heart, it is termed cardiac
tamponade.
• Symptoms are severe edema, low BP, shortness of breath,
dizziness, chest pain, cough, rapid pulse.
• Causes are inflammation, rheumatoid arthritis, surgery, cancer,
infection, kidney failure, hemorrhage, trauma or idiopathic.

20. • Treatment: Giving NSAIDS, excess fluid drained using a needle
or in severe cases, surgery.
PERICARDITIS:
• Inflammation of the pericardium.
• Infections that can cause pericarditis include viral infections,
bacterial infections, tuberculosis, and fungal infections. Patients
with AIDS frequently develop infections that produce pericarditis.

21.  Pericarditis occurs in up to 15% of patients who have acute
myocardial infarctions (heart attacks). There is also a late form of
post-heart-attack pericarditis, called Dressler’s syndrome, that
occurs weeks to months after the heart attack.
• Some of the drugs that can produce pericarditis include
procainamide, hydralazine, phenytoin, and isoniazid.

22. • “IDIOPATHIC" pericarditis.”
• Chest pain, can be severe, made worse by changing position or
with deep breathing. shortness of breath, or fever.
• Tamponade, chronic pericarditis, and constriction– can produce
reduced cardiac pumping, lung congestion, and organ failure.

23. • Most cases of acute pericarditis resolve within a few weeks,
and leave no permanent cardiac problems.
• Chronic pericarditis is treated by identifying and treating
the underlying cause, if possible.