The pericardium is a double-walled sac that surrounds the heart and roots of the great vessels. It has two layers - an outer fibrous pericardium and inner serous pericardium. The serous pericardium further divides into the parietal pericardium fused to the fibrous layer and the visceral pericardium lining the fibrous layer and covering the heart. Between these layers is the pericardial cavity lubricated with fluid. The pericardium supports and protects the heart, and its layers are supplied by nerves and blood vessels.

1. PERICARDIUM
Prepared by:
Sharmin Susiwala

4. The pericardium is a double-walled conical
fibro-serous sac, in which the heart and the roots
of the great vessels are contained.

5. • BOUNDARIES:
• In front: It is separated from the anterior wall of the
thorax, by the lungs and pleuræ and usually corresponding
with the left half of the lower portion of the body of the
sternum and the medial ends of the cartilages of the fourth
and fifth ribs of the left side
• Behind: It rests upon the bronchi, the esophagus, the
descending thoracic aorta, and the posterior part of the
mediastinal surface of each lung.
• Laterally: It is covered by the pleuræ, and is in relation
with the mediastinal surfaces of the lungs; the phrenic
nerve, with its accompanying vessels, descends between
the pericardium and pleura on either side.

6. Structure of Pericardium
There are two layers to the pericardial
sac:
1. Outermost fibrous pericardium
2. Inner serous pericardium

8. 1.Fibrous pericardium:
 The fibrous pericardium forms a flask-shaped bag, the
neck of which is closed by its fusion with the external coats
of the great vessels, while its base is attached to the central
tendon and to the muscular fibers of the left side of the
diaphragm.
 It is also attached to the posterior surface of the sternum
by the superior and inferior sternopericardiac
ligaments; the upper passing to the manubrium, and the
lower to the xiphoid process.
 The vessels receiving fibrous prolongations from this
membrane are:
- aorta,
- superior vena cava,
- right and left pulmonary arteries
- the four pulmonary veins.
 The inferior vena cava enters the pericardium through the
central tendon of the diaphragm, and receives no covering
from the fibrous layer.

9. 2.Serous Pericardium:
 The serous pericardium, in turn, is divided into
two layers:
- the parietal pericardium, which is fused to and
inseparable from the fibrous pericardium,
- the visceral pericardium, which is part of
the epicardium; covers the heart and the great
vessels and lines the fibrous pericardium.
 It is invaginated by the heart
 In between the parietal and visceral pericardial
layers there is a potential space called
the pericardial cavity.
 It is normally lubricated by a film of pericardial
fluid, which protects the heart from any kind of
external jerk or shock.

10. • BLOOD SUPPLY:
- Internal mammary a.
- Descending thoracic aorta.
• NERVE SUPPLY:
- Vagus n.
- Phrenic n.
- Sympathetic trunks.

11. • FUNCTIONS:
1. Fixes heart in mediastinum and limits its motion
2. Protection from infections coming from other organs (such as
lungs)
3. Prevents excessive dilation of heart in cases of acute volume
overload
4. Lubrication

12. • ANATOMICAL RELATIONS:
o Surrounds heart and bases of pulmonary artery and aorta.
o Deep to sternum and anterior chest wall.
o The right phrenic nerve passes to the right of the
pericardium.
o The left phrenic nerve passes over the pericardium of the
left ventricle.
o Pericardial arteries supply blood to the dorsal portion of
the pericardium.

13. • APPLIED ANATOMY:
Pericarditis resulting in pericardial friction rub.
Pericardial effusion which may lead to cardiac
tamponade.
Cardiac Tamponade as a primary pathology following
traumatic injury.
Pericardial Sinus.