Heart 1 - Pericardium - Dr Kumar

Where is the pericardial cavity and what does it contain?

-between the visceral serous pericardium and the parietal serous pericardium -Contains a thin film of serous pericardial fluid (2-3ml)

The divisions of the pericardium connect at the hilum of lung. What are the divisions?

1.Fibrous pericardium - dense fibrous envelope. 2.Serous pericardium visceral (Epicardium) parietal pericardium

Where is the superior mediastinum located ?

Above the angle of Louis aka the sternal angle.

Why is the area of superficial cardiac dullness clinically important?

Approach to pericardiocentesis, window for echocardiography, intracardiac injections

What is Beck's Triad in relation to cardiac tamponade signs/ symptoms?

Beck's triad: Increased jugular venous pressure causing dilated neck veins Hypotension Diminished heart sounds.

Where is the inferior mediastinum located?

Below the plane passing through the angle of Louis, so sternal angle to T4 inferior border.

What is a common xray presentation of cardiac tamponade?

Bottle shaped cardiac presentation. This antero-posterior view chest radiograph shows a massive bottle-shaped heart and conspicuous absence of pulmonary vascular congestion.

phrenic nerve...complete this sentence...C3,4,5 keeps the ______ alive?

Diaphragm

What is the lymphatic drainage of the pericardium?

Drain into mediastinal nodes and thoracic duct directly.

What is meant by "blind insertion" in pericardiocentesis?

Ideally, 2-D echocardiograpy is used to guide needle insertion and catheter. The needle is then inserted into the left xiphocostal angle perpendicular to the skin and 3 to 4 mm below the left costal margin and advanced directly into the inner aspect of the rib cage.

The pericardium is in the middle mediastinum. What is the function of the pericardium?

Keeps the heart contained in the chest cavity. Prevents the heart from over expanding when blood volume increases. Limits heart motion

What are the borders of the transverse sinus? Why is this clinically important?

Lies between: -Great vessels anteriorly [aorta and pulmonary trunk] -SVC posteriorly This is clinically important because during Open heart surgery, clamp is passed here to block the blood flow while patient is put on artificial heart-lung machine.

What is another mnemonic for posterior mediastinum?

Mediastinums: posterior mediastinum structures There are 4 birds: The esophaGOOSE (esophagus) The vaGOOSE nerve The azyGOOSE vein The thoracic DUCK (duct)

Why does a person having a myocardial infarction experience shoulder pain?

Phrenic nerve is affected during cardiac pain therefore referred to shoulders in the levels of C3 to C5.

What is the mnemonic for remembering the contents for the posterior mediastinum?

Posterior mediastinum: contents DATES: Descending aorta Azygos and hemiazygous veins Thoracic duct Esophagus Sympathetic trunk/ganglia

Where is the oblique sinus and what is it's function?

Space in the serous pericardium behind the left atrium. Separates LA from posterior mediastinal structures - esophagus and thoracic aorta

Another mnemonic for remembering the superior mediastinum contents?

Superior mediastinum contents "BATS & TENT": Brachiocephalic veins Arch of aorta Thymus Superior vena cava Trachea Esophagus Nerves (vagus & phrenic) Thoracic duct

What is the mnemonic for remembering the superior mediastinum contents?

Superior mediastinum: contents PVT Left BATTLE: Phrenic nerve Vagus nerve Thoracic duct Left recurrent laryngeal nerve (not the right) Brachiocephalic veins Aortic arch (and its 3 branches) Thymus Trachea Lymph nodes Esophagus

What is the pericardium?

The pericardium is the fluid filled sac that surrounds: the heart the proximal ends of the aorta and pulmonary trunk. the proximal ends of vena cavae

How is the transverse sinus developed?

The transverse sinus develops when the primordial artery and venous ends are brought together.

What are the two pericardial sinuses?

Transverse Sinus Oblique sinus

What is the nerve supply of the visceral area of the pericardium?

Visceral layer: Coronary plexus from the vagi (parasympathetic-inhibitory) T1 to T5 sympathetic ganglia via cardiac branches (Cardioaccelerator, vasodilator and sensory)

What three parts does the inferior mediastinum have?

anterior, middle and posterior sections.

Excessive accumulation of fluid in the pericardial cavity leads to pericarditis, which in turn causes what condition?

may lead to restriction of the heart movement may lead to engorged neck veins and cardiac arrest (cardiac tamponade)

Where is the area of superficial cardiac dullness?

pleura-Area of superficial cardiac dullness -(4th-6th CC on left)