pericardium

Beck's triad for cardiac tamponade.

(1) HYPOTENSION (2) MUFFLED or DISTANT HEART SOUNDS (3) JUGULAR VENOUS DISTENSION (JVD) ***Physical Exam: -Tachycardia, -Hypotension+++ - PULSUS PARADOXUS (↓ in systolic BP on inspiration >10mm Hg). Tx: PERICARDIOCENTESIS

anterior mediastinum contains

-internal thoracic artery and vein -thymus may extend down into it

pericardium (pericardial sac)

A double layered covering forms a sac around the heart and roots of the great vessels.

what are the 3 layers of the heart?

A. Epicardium- the outer layer (visceral pericardium) B. Myocardium- muscular layer (thickest) C. Endocardium- the inner layer

Pericardial effusion

Accumulation of fluid in the pericardial space resulting from inflammation caused by acute pericarditis Commonly leakage of fluid from the pericardial capillaries. Fluid compresses the heart and inhibits filling

Cardiac tamponade

Acute compression of the heart caused by a rapid accumulation of fluid or blood from wounds to the heart. Effects- compression of venous return to the heart, decreased diastolic capacity, reduced cardiac output with increased heartrate, increased venous pressure with jugular distention amongst others signs

what are the 3 layers of the pericardium

Fibrous pericardium -outermost layer of connective tissue. Fused to the central tendon of the diaphragm. Serous pericardium - composed of two layers with serous fluid between them • Outer parietal • Inner visceral (which is the epicardium of the heart)

oblique sinus of pericardium

Subdivision of the pericardial sac behind the heart. Surrounded by the reflection of the serous pericardium around the right and left pulmonary veins and inferior vena cava. A hand slipped behind the apex of the heart and extended upward until stopped by the reflection of pericardium would be in this sinus

paradoxic pulse (pulsus paradoxus)

abnormally large decrease in stroke volume, systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mmHg. When the drop is more than 10 mmHg, it is referred to as pulsus paradoxus

superior mediastinum

above sternal angel (2nd costal cartilage)

what is the benefit of having serous fluid between the parietal and visceral layers of the serous pericardium?

allows more movement with less friction... can be a potential site for infection, or fluid can get in there

pericardiacophrenic (pericardiophrenic) vessels and phrenic nerves run...

bilaterally along the fibrous pericardium.

Mediastinum

central compartment between the pleural sacs containing the lungs

Pericardial Effusion and Cardiac Tamponade

complications of pericarditis pericardial effusion can lead to cardiac tamponade! (see below) Pericardial effusion is the acute or chronic accumulation of fluid in the pericardial space (between the parietal and the visceral pericardium) and is often associated with a variety of underlying disorders. The fluid can be either bloody (e.g., following aortic dissection) or serous (usually idiopathic). As the pericardium is rather stiff, the capacity of the pericardial space is limited. In chronic effusion, the pericardium can stretch to a certain degree, accommodating slightly more fluid. In the acute setting, however, the added volume quickly exceeds the maximum capacity of the pericardial space. In both cases, the end result is often cardiac tamponade: compression of the heart which can lead to a life-threatening reduction in cardiac output. Pericardial effusion is initially asymptomatic, but cardiac tamponade has a distinct clinical presentation, including hypotension, tachycardia, jugular venous congestion, and pulsus paradoxus. Echocardiography is the most important diagnostic procedure and usually reveals an anechoicpericardial space. Treatment depends on hemodynamic stability: unstable patients require quick pericardial fluid drainage, through either pericardiocentesis or surgery, whereas in stable patients, treatment focuses on the underlying disease

Pericardium is attached to the ....

diaphragm

inferior mediastinum

divided into anterior, middle, and posterior parts below sternal angle

The visceral layer of the serous pericardium is also known as the

epicardium of the heart.

coronary sulcus

groove that marks border between atria and ventricles

Pericarditis

inflammation of the pericardium. Could cause a pericardial rub (friction) or murmur. A rub is friction between the layers of pericardium. Can be heard on auscultation. Symptoms... -dysphagia -dyspnea and cough -inspiratory chest pain -paradoxic pulse

Endocardium

inner layer, lines heart

Purkinje fibers

located in the innermost layer of the myocardium cells (not fibers!!) Modified Cardiomyocytes that are the terminal end of the conducting system. Have glycogen that distinguishes them in the tissue section

Myocardium

middle layer, muscle layer. Purkinje Fibers-Located in the myocardium, just inside the endocardium.

The heart is located in the ______- mediastinum.

middle medisatum part of inferior mediastinum

Epicardium (visceral pericardium)

outer layer mostly Connective Tissue Location of the Major Blood Vessels.

what maintains blood supply to the fibrous pericardium?

pericardiacophrenic artery and vein

middle mediastinum contains

pericardial sac heart roots of great vessels

fibrous and parietal portion of the serous pericardium are innervated by....

phrenic nerve (C3,C4, C5) this is why refered pain from the heart shows up in the C3,4,5 dermatome!!! (shoulder) ex pericarditis

transverse sinus of the pericardium

posterior to the ascending aorta and the pulmonary trunk Anterior to the Superior vena cava. It is important for surgical procedures in this area, especially ligature of the vessels with use of the heart-lung machine. Important landmark for surgery of the aorta or pulmonary artery. Surgeon can ligature a vessel by passing a suture through this space and around the vessel

pericardial cavity

space between the two layers of the serous pericardium -parietal layer -visceral layer (epicardium) contains serous fluid

Pericardiocentesis... where to place needle?

surgical puncture of the pericardial cavity for aspiration of fluid. Needle through fifth intercostal space left of the sternum

Pericardial sinuses (2)

transverse sinus and oblique sinus