Anatomy Thorax Symposium

7/31/2019 Anatomy Thorax Symposium

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The pericardium

and

the pericardial sinuses


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Pericardium:

(Peri-around, Cardium-heart)

It is a double-walled, fluid filled sac.

It contains the heart and the juxtacardiac parts of itsgreat vessels(the aorta, the vena cava and thepulmonary artery).


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Functions of the pericardium:

Keeps the heart contained in the thoraciccavity(cardiac seat belt).

Prevents over-expanding of heart when blood

volume increases.

Limits the hearts movements.

Acts as a shock absorber with the help of thefluid filled sac.


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Pericardium

Inner Serous

layer

Inner

visceral

OuterParietal

Outer

Fibrous layerSingle Layer


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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 adventitiaof the great vessels and also the pre-trachealfascia.

Inferiorly, it is attached the the central tendonof the diaphragm and a small muscular part ofits left side.


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Anteriorly, it is attached to the posteriorsurface of the sternum by superior and inferior

sternopericardial ligaments. The extents ofthese ligaments are extremely variable and thesuerior one is often undetectable.

The pericardium is securely anchored bythese attachments and maintains the generalthoracic position of the heart, serving as thecardiac seat belt.


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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 sternalends of the left 4th and 5th costal cartilages , thepericardium is in direct contact with the thoracic

wall. Until it regresses, the lower end of the

thymus is anterior to the upper part.


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Posteriorly, The principal bronchi, the esophagus, the

esophageal plexus, the descending thoracicaorta, and the posterior parts of the mediastinalsurface of both lungs.

Laterally, Pleural coverings of the mediastinal surface

of the lungs. The phrenic nerve with its accompaning

vessels, descends between the mediastinalpleura and the fibrous pericardium on eitherside.


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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 fibrouspericardium except the inferior vena cava whichtraverses the central tendon.


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SEROSAL PERICARDIUM:

It is closed sac within the fibrous

pericardium and has a visceral and a parietallayer.

The visceral layer or the epicardium coversthe heart and the great vessels and isreflected into the parietal layer which lines theinner surface of the fibrous pericardium.

The reflections of the serosal layer are

arranged as two complex tubes : the aortaand the pulmonary trunk are enclosed minone and the superior and inferior vena cavaeand the pulmonary veins in the other.


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The tube surrounding the veins has aninverted 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.


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Vascular supply and lymphatic

drainage:

The arteries are derived from the internalthoracic, the musculophrenic arteries and thedescending thoracic aorta.

The veins are tributaries of the azygoussystem.

Innervation:

The pericarduium is innervated by the vagus,together with the phrenic nerves and thesympathetic trunks


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Applied aspects:

Pericardial effusion: Accumulation of excess fluid in thepericardial 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, rheumatoidarthritis, surgery, cancer, infection, kidneyfailure, hemorrhage, trauma or idiopathic.


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Treatment: Giving NSAIDS, excess fluid drained

using a needle or in severe cases, surgery.

PERICARDITIS:

Inflammation of the pericardium.

Infections that can cause pericarditis includeviral infections, bacterial infections, tuberculosis,

and fungal infections. Patients with AIDSfrequently develop infections that producepericarditis.


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Autoimmune disorders that can causepericarditis include rheumatoid arthritis, lupus,

and scleroderma.

Pericarditis occurs in up to 15% of patients whohave acute myocardial infarctions (heartattacks). There is also a late form of post-heart-attack pericarditis, called Dresslers syndrome,

that occurs weeks to months after the heart

attack.

Some of the drugs that can produce pericarditisinclude procainamide, hydralazine, phenytoin,

and isoniazid.


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Many forms of cancer can metastasize (spread) tothe pericardial sac, and produce pericarditis.In manycases, no definite cause for pericarditis can beidentified - this is called idiopathic" pericarditis.

The most common symptom caused by pericarditisis 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, namelytamponade, chronic pericarditis, and constriction.

These complications - which are discussed belowcan produce reduced cardiac pumping, lungcongestion, and organ failure.


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Acute pericarditis is treated by a) identifying theunderlying cause, b) treating the underlying cause,

c) giving anti-inflammatory drugs (to reduceinflammation and help prevent chronic problems),and d) giving analgesics to control the pain. Mostcases of acute pericarditis resolve within a fewweeks, 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 theheart, and restores normal cardiac function almostimmediately.


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Chronic pericarditis is treated by identifying and

treating the underlying cause, if possible. Ifrecurrent pericardial effusions become a problem,surgery can be done to create a permanent openingthat allows the fluid to drain from the pericardial sac,

thus preventing tamponade.

Constrictive pericarditis is a very difficulttherapeutic problem. Symptoms can be treated with

bed rest, diuretics, and digitalis, but definitivetreatment requires surgery to strip the thickenedpericardial lining from the heart. This surgery isusually quite difficult


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Anatomy Thorax Symposium

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