The pericardium is a double-walled sac that surrounds the heart and prevents overexpansion. It has an outer fibrous layer and inner serous layer. The pericardium supports the heart, limits its movement, and acts as a shock absorber. Pericardial effusion or inflammation can occur from infection, cancer, or other causes. Effusion is treated by draining fluid while inflammation is treated with anti-inflammatory drugs or identifying the underlying cause. Complications like tamponade require draining fluid from the pericardial sac.

1. The pericardium
and
the pericardial sinuses

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. 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.

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

6. 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 and a small muscular part of
its left side.

7.  Anteriorly, it is attached to the posterior
surface of the sternum by superior and inferior
sternopericardial ligaments. The extents of
these ligaments are extremely variable and the
suerior 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‟.

8. Relations:
Anteriorly,
 Seperated from the thoracic wall by the lungs
and the pleural coverings.
 But,in a small area behind the lower left
halfof 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.

9. 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.

10. Inferiorly,
 the pericardium is seperated from the liver and
the fundus of stomach by the diaphragm.
The aorta, the superior vena cava, the pulmonary
arteries and veins receive extensions of the fibrous
pericardium except the inferior vena cava which
traverses the central tendon.

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

13.  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. Vascular supply and lymphatic
drainage:
• The arteries are derived from the internal
thoracic, the musculophrenic arteries and the
descending thoracic aorta.
• The veins are tributaries of the azygous
system.
Innervation:
• The pericarduium is innervated by the
vagus, together with the phrenic nerves and
the sympathetic trunks

17. 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.

19. • 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.  Autoimmune disorders that can cause
pericarditis include rheumatoid
arthritis, lupus, and scleroderma.
 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

22. • Many forms of cancer can metastasize (spread) to
the pericardial sac, and produce pericarditis.In many
cases, no definite cause for pericarditis can be
identified - this is called “idiopathic" pericarditis.”
• The most common symptom caused by pericarditis
is chest pain. The pain can severe, and is often made
worse by changing position or with deep breathing.
Patients can also have shortness of breath, or fever.
• Pericarditis can produce complications, namely
tamponade, chronic pericarditis, and constriction.
These complications - which are discussed below –
can produce reduced cardiac pumping, lung
congestion, and organ failure.

23. • Acute pericarditis is treated by a) identifying the
underlying cause, b) treating the underlying cause,
c) giving anti-inflammatory drugs (to reduce
inflammation and help prevent chronic problems),
and d) giving analgesics to control the pain. Most
cases of acute pericarditis resolve within a few
weeks, and leave no permanent cardiac problems.
• Tamponade is treated by draining the fluid from
the pericardial sac, usually via a tiny catheter.
Removing the fluid relieves the pressure on the
heart, and restores normal cardiac function almost
immediately.

24. • Chronic pericarditis is treated by identifying and
treating the underlying cause, if possible. If
recurrent pericardial effusions become a
problem, surgery can be done to create a
permanent opening that allows the fluid to drain
from the pericardial sac, thus preventing
tamponade.
• Constrictive pericarditis is a very difficult
therapeutic problem. Symptoms can be treated with
bed rest, diuretics, and digitalis, but definitive
treatment requires surgery to strip the thickened
pericardial lining from the heart. This surgery is
usually quite difficult