HEART- Dr.

Fernandez  Contains the pericardial

fluid: acts as a lubricant
Pericardium and Heart to facilitate movements

1. What is a pericardium? 3. What are the different pericardial sinuses and

its location?
Pericardium
WHAT: fibroserous sac that encloses the heart and Pericardial Sinuses:
the roots of the great vessels
o spaces posterior to the heart by the
FUNCTION:
reflections of the serous pericardium
- Restrict excessive movements of the heart as a
around the great vessels.
whole
o Forms as a consequence of the way the
- Lubricated container in which the different
heart bends during the development
parts of the heart can contract free of the
o Extensions of the pericardial cavity and
surrounding structures.
not separate compartments
WHERE: Middle Mediastinum
A. Oblique Sinus: reflection around the
Posterior to: body of sternum & 2nd and 6th costal
large veins and forms an inverted U-
cartilages
shaped cul-de-sac
Anterior to: 5th-8th throracic vertebra
COURSE:
Superior: Great blood vessels
- Runs along the long axis of the
Inferior Diaphragm
heart, from the apex to the
ascending aorta.
2. What are the layers of the pericardium?
B. Transverse Sinus: relatively short
LAYERS:
horizontal space between the reflection
of the serous pericardium around the
A. Fibrous Pericardium aorta and pulmonary trunk and the
o strong fibrous outer layer of the sac reflection around the large veins.
o WHERE:
 Attaches below to the central
tendon of the diaphragm 4. Where are the different attachments of the
through the: pericardiophrenic pericardium located?
ligament.
 Attaches in front of the sternum Fibrous
by fibrous bands:
sternopericardial ligaments
 Pericardiophrenic Ligament: attaches the
 Fuses with the outer coats of
pericardium to the central tendon of the
the great blood vessels passing
diaphragm
through it namely:
 Sternopericardial Ligament: attaches the
 Aorta
pericardium to sternum; fibrous bands
 Pulmonary Trunk
 Superior Vena Cava
Serous
 Inferior Vena Cava
 Pulmonary Veins
 Parietal: Lines the fibrous pericardium; reflected
B. Serous Pericardium
around the roots of the great vessels and
o Lines the fibrous pericardium and coats
becomes continuous with the epicardium.
the heart.
 Visceral/ Epicardium: Closely applied to the
o Divided into:
heart
 Parietal Layer
 Lines the inner surface
of the fibrous
pericardium
5. What is pericarditis and its associated disease
 reflects around the
condition?
roots of the great
vessels to become
Pericarditis
continuous with the
visceral layer (closely
 Inflammation of the pericardium
covers the heart)
 Visceral Layer
Acute Pericarditis:
 “epicardium”
 Closely applied to the
superficial surface of  Roughening of the visceral and parietal
the heart layers of serous pericardium by
 Pericardial Cavity inflammatory.
 Slitlike space between  Produces pericardial friction rub which can
the parietal and visceral be felt on palpation and heard through the
layers stethoscope
Constrictive Pericarditis

 Occurs when the fibrous pericardium becomes

too rigid because of inflammation
 Results in heightened resistance to movements
of the heart and blood flow

Cardiac Tamponade: associated disease

 Excessive pericardial fluid may accumulate

in the pericardial activity , which can
compress the thin-walled atria and interfere
with the filling of the heart during diastole
 can also occur secondary to stab or gunshot
wounds when the chambers of the heart
have been penetrated . Blood escapes into
the pericardial cavity and can restrict the
filling of the heart

TREATMENT:

Paracentesis

 pericardial fluid aspirated from the pericardial

cavity (excessive accumulation due to
pericarditis)
 Needle can be introduced to the left of the
xiphoid process in an upward and backward
direction at an angle of 45 degrees to the skin
 When paracentesis is performed at this site, the
pleura and lung are not damaged, because of
the presence of the cardiac notch.

6. Where in the mediastinum is the heart located?

Heart

 an enlarged, internally subdivided blood

vessel specialized for pumping.
 Unique feature: myocardial layer composed
largely of cardiac muscle

Location

 Lies within the pericardium in the middle

mediastinum
 Connected at its base to the grat blood
vessels

7. What are the significant surface anatomy of the

heart and its relation to the mediastinum?

8. What are the structures seen in the anterior and

posterior surface of the heart

9. What does the heart contain?