The pericardium is composed of two layers - the outer fibrous pericardium and inner serous pericardium. The fibrous pericardium surrounds and protects the heart, while the serous pericardium forms a double-layered sac with a fluid-filled space between. The serous pericardium has a parietal layer lining the fibrous pericardium and a visceral layer attached to the heart. Conditions like pericarditis cause inflammation of the pericardium, while pericardial effusion occurs when excess fluid accumulates in the pericardial space, which can lead to cardiac tamponade.

1. PericardiumPericardium
Maj Dr. Poonam SinghMaj Dr. Poonam Singh

2. PericardiumPericardium
 Fibroserous sac surrounding heart & root ofFibroserous sac surrounding heart & root of
great vessels.great vessels.
 Two components: outer fibrous pericardiumTwo components: outer fibrous pericardium
Inner serous pericardiumInner serous pericardium
 Outer parietal layer inner visceral layerOuter parietal layer inner visceral layer
 Two are continuous at root of great vesselsTwo are continuous at root of great vessels
 Narrow fluid filled space -pericardial cavityNarrow fluid filled space -pericardial cavity

3. Layers of PericardiumLayers of Pericardium

4. Sagittal section : PericardiumSagittal section : Pericardium

5. Fibrous Pericardium:Fibrous Pericardium:
 Apex blunt,fused to roots of great vessels and PTfasciaApex blunt,fused to roots of great vessels and PTfascia
 Base inseparable from the diaphragm (central tendon)Base inseparable from the diaphragm (central tendon)
 Ant attached to sternum by Sternopericardial lig.Ant attached to sternum by Sternopericardial lig.
 Post related to principal bronchi & oesophagusPost related to principal bronchi & oesophagus
 On each side related to mediastinal pleura, Phrenic nerveOn each side related to mediastinal pleura, Phrenic nerve
 Phrenic N innervating diaphragm passes through FP &Phrenic N innervating diaphragm passes through FP &
innervates itinnervates it
 Protects heart from sudden overfillingProtects heart from sudden overfilling

6. Fibrous Pericardium - relations

7. Phrenic nerve innervationsPhrenic nerve innervations

8. Serous Pericardium:Serous Pericardium:
 Thin double layered serous membrane lined byThin double layered serous membrane lined by
MesotheliumMesothelium
 Outer Parietal and inner Visceral PericardiumOuter Parietal and inner Visceral Pericardium
 two layers continuous with each other at the root oftwo layers continuous with each other at the root of
great vessels ( ascg aorta, SVC, IVC, pulm trunk &great vessels ( ascg aorta, SVC, IVC, pulm trunk &
pulm veins)pulm veins)
 Visceral layer - adherent to the heartVisceral layer - adherent to the heart
 P cavity is a potential space b/w these two layersP cavity is a potential space b/w these two layers
 Contains a thin film of capillary fluid that helps toContains a thin film of capillary fluid that helps to
lubricatelubricate

9. Pericardial sinuses
 Transverse sinusTransverse sinus
 Oblique sinusOblique sinus
Reflections of
visceral layer of
peritoneum around
great vessels of the
heart

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11. 1313

12. 1414

13. Transverse Sinus
 Horizontal gap between the
arterial ends of heart
tubes in front and venous
ends behind
 Ant: Ascending aorta
Pulmonary trunk
 Post: SVC
 On each side it opens into
P cavity

14. Transverse Sinus
 Horizontal gap between
the arterial ends of
heart tubes in front
and venous ends behind
 Ant: Ascending aorta
Pulmonary
trunk
 Post: SVC
 On each side it opens
into P cavity

15. Oblique Sinus:Oblique Sinus:
 Formed by reflectionsFormed by reflections
of pericardium ontoof pericardium onto
pulm veins of heartpulm veins of heart
 Cul-de-sac/cardiacCul-de-sac/cardiac
bursabursa
 Ant: by the Lt AtriumAnt: by the Lt Atrium
 Post: by PPPost: by PP
 below it opens into thebelow it opens into the
P cavityP cavity

16. BloodBlood supply::
Brs of Int Th artery, musculophrenic
artery and
descending thoracic aorta
Nerve Supply:
FP & PP - by Phrenic nerve, pain sensitive.
VP - by ANS: Cardiac plexus. pain insensitive

17. Applied:Applied:
 Pericarditis:Pericarditis: Inflammation of the pericardiumInflammation of the pericardium
 Pericardial Effusion:Pericardial Effusion: Excess fluid withinExcess fluid within
pericardial sac- may lead topericardial sac- may lead to Cardiac TamponadeCardiac Tamponade
compressing the heartcompressing the heart
 Constrictive Pericarditis:Constrictive Pericarditis: Abnormal thickeningAbnormal thickening
of the pericardium compresses the heartof the pericardium compresses the heart
impairing heart functionimpairing heart function

19. APEX BEAT PALPATION
PERICARDIAL EFFUSION
Pericardial EffusionPericardial Effusion

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PericardiocentesisPericardiocentesis