Transcript Paricardium Lecture By Dr Muhammad Shahid Saeed

Lecture on pericardium
and pericardial fluid
By
Dr.Muhammad shahid
saeed
PERICADIUM
• The membranous sac filled with serous fluid
that encloses the heart and the roots of the
aorta and other large blood vessels.
– A superficial fibrous pericardium.
– A deep two-layer serous pericardium:
• The parietal layer lines the internal surface of the
fibrous pericardium
• The visceral layer or epicardium lines the surface of the
heart
• They are separated by the fluid-filled pericardial cavity.
Layers of pericardium
• Fibrous Pericardium
• • It is a sac made up of connective tissue fully
surrounding the heart with out being attached to it
• It is roughly conical in shape
• It is superiorly connected with tunica adventitia of
great vessels
• Inferiorly it is connected with central tendon of
diaphragm
• Anteriorly it is separated from thoracic wall by lung &
pleura, however some portion of it is in direct relation
with left half of lower part of body of Sternum and
left 4th &5th costal cartilages
• Posteriorly it is related to esophagus
descending thoracic Aorta & posterior part of
mediastinal surface of both lungs
• Serous Pericardium
• •It is closed sac within fibrous pericardium
having Visceral & Parietal layer
• •The visceral layer of serous pericardium
(epicardium) covers the surface of the heart
• •It also reflects onto the great vessels
•From around the great vessels, the serous
pericardium reflects to line the internal aspect
of the fibrous pericardium as the parietal
• layer of serous pericardium
• Transverse Sinus
• The transverse sinus is bounded anteriorly by
the serous pericardium covering the posterior
aspect of the pulmonary trunk and aorta, and
posteriorly by the visceral pericardium covering
the atria
• The transverse pericardial sinus is especially
important to cardiac surgeons.
• After the pericardial sac has been opened
anteriorly, a finger can be passed through
the transverse pericardial sinus posterior to
the aorta and pulmonary trunk.
• By passing a surgical clamp or placing a
ligature around these vessels, inserting the
tubes of a coronary bypass machine, and
then tightening the ligature, surgeons can
stop or divert the circulation of blood in
these large arteries while performing cardiac
surgery.
Oblique Sinus
The oblique sinus is bounded
a. anteriorly by the visceral layer of serous
pericardium covering the left
atrium
b. posteriorly by the parietal layer of serous
pericardium lining the fibrous pericardium,
c. superiorly and laterally by the reflection of
serous pericardium around the four pulmonary
veins and the superior and inferior venae cavae
• tamponade Cardiac
• • Cardiac tamponade (heart compression) is
due to
• critically increased volume of fluid outside the
heart but inside the pericardial cavity; e.g.,
due to stab wounds or from perforation of a
weakened area of the heart muscle after heart
attack (hemopericardium).
Pericardial fluid is a liquid that acts as
a lubricant for the movement of the
heart. It is found in small quantities
between
the
two
layers
of
thepericardium. Pericardial fluid is
produced by mesothelial cells in the
membranes and acts to reduce friction
as the heart pumps

About 20-60 ml of pericardial fluid is present in the sac .
• The average amount of fluid is 15-30 ml.
• This is produce by the process of ultrafiltration with very
low amount of proteins that is why it is transudate in
nature.
• It is consisted of
1. Water
2. Sodium
3. Chloride
4. Magnesium
5. Potassium
6. LDH
 The Proteins are present in the form of albumin
globulin and fibrinogen but there concentration is less
than that of plasma.
As for as the cells are concerned the following cells are
present in the pericardial fluid.
1.Mesothelial cells
2.Lymphocytes
3.Granulocytes
4.Macrophages
5.Eosinophil
6.Basophil
Lymphocyte are the cells which are present in
abundance in the pericardial fluid.
Functions:1. lubricating the moving surface of heart .
2. Stabilizing the heart.
3. isolation of the heart from adjacent structures so that
the inflammatory and neuplastic extension towards heart
is inhabitant.
4. limiting the heart dilatation during diastole.
5. Prevention of cardiac hyperthrophy during cardiac
overload.
6. reducing right ventricular impulse work during left
ventricular overload.
7. Preservation of negative endothoraxic which is
important for the filling of atria.
8. The Nervous stimulation response and regulation of
cardiac frequency and blood pressure.
Pericardial Fluid Analysis
•
•
•
Pericardial fluid analysis is used to help diagnose the cause of inflammation of the pericardium called
pericarditis and/or fluid accumulation around the heart (pericardial effusion). There are two main reasons
for fluid accumulation, and an initial set of tests (fluid protein or albumin level, cell count, and
appearance) is used to differentiate between the two types of fluid that may be produced.
An imbalance between the pressure within blood vessels (which drives fluid out of the blood vessel) and
the amount of protein in blood (which keeps fluid in the blood vessel) can result in accumulation of fluid
(called a transudate. Transudates are most often caused by congestive heart failure or cirrhosis. If the fluid
is determined to be a transudate, then usually no more tests on the fluid are necessary.
Injury or inflammation of the pericardium may cause abnormal collection of fluid (called an exudate).
Exudates are associated with a variety of conditions and diseases and several tests, in addition to the
initial ones performed, may be used to help diagnose the specific condition, including:
– Infectious diseases – caused by viruses, bacteria, or fungi. Infections may originate in the
pericardium or spread there from other places in the body. For example, pericarditis may follow a
respiratory infection.
– Bleeding – bleeding disorders and/or trauma can lead to blood in the pericardial fluid.
– Inflammatory conditions – pericarditis may follow a heart attack, radiation treatment, or be part of
autoimmune disorders such as rheumatoid arthritis and systemic lupus erythematosus.
– Cancer – such as mesothelioma that has arisen in the pericardium or metastatic cancer that has
spread to it.
Pericardial fluid analysis
• Chest pain, sharp or sometimes dull, that may be
relieved by bending forward
• Coughing
• Difficulty breathing
• Fever
• Fatigue
• Changes in heart rhythm
• Enlarged heart size on chest X-ray
• Abnormal pericardial appearance on
echocardiogram
Transudate VS Exudate fluid.
• Transudate
• Transudates are most often caused by either congestive heart
failure or cirrhosis. Typical fluid analysis results include:
• Physical characteristics—fluid appears clear
• Protein or albumin level—low
• Cell count—few cells are present
• Exudate
• Exudates can be caused by a variety of conditions and diseases.
Initial test results may show:
• Physical characteristics—fluid may appear cloudy
• Protein or albumin level—high
• Cell count—increased