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A lorry driver with chest pain
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
This condition is a medical emergency. Cardiac tamponade occurs when fluid (either blood or a pericardial effusion) collects between the visceral and parietal pericardium. As the outer fibrous pericardium is relatively inelastic, the heart volume is compromised by the fluid collection within the pericardial cavity. The rising intrapericardial pressure gradually reduces ventricular filling, and thus cardiac output. Eventually mechanical pump failure and death ensue.
Functions of the Cardiovascular System
Published in Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal, Principles of Physiology for the Anaesthetist, 2020
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal
The heart is a muscular pump with four chambers: the right atrium and ventricle and the left atrium and ventricle. Blood flowing through the chambers of the right side of the heart has no direct connection with the chambers of the left side; the right and left sides of the heart are two pumps in series, separated by the pulmonary and systemic vessels. Blood from the systemic veins is carried by the superior and inferior venae cavae to the right atrium, then is pumped by the right ventricle at low pressure into the pulmonary artery, passes through the pulmonary capillaries, is carried by the four pulmonary veins to the left atrium and is pumped by the left ventricle at high pressure into the aorta to perfuse the systemic tissues once more. The walls of cardiac chambers are made of cardiac muscle, the myocardium, which is lined inside by endothelium and outside by mesothelial epicardium. The thin but fibrous pericardium encloses and limits sudden overdistension of the heart chambers. The pericardial space contains a small amount of lubricating pericardial fluid.
Pericardial disease in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
The pericardium is a thin covering around the heart that separates it from other mediastinal structures (1,2). The normal pericardium consists of two sacs: an outer (fibrous) pericardium and an inner double-layered serous pericardium. The serous pericardium comprises visceral pericardium (or epicardium) and parietal pericardium. The visceral pericardium surrounds the heart and proximal great vessels and is reflected to form a parietal layer which lines the fibrous pericardium. The visceral pericardium has an external layer of flat mesothelial cells, which lies on a stroma of fibrocollagenous support tissue. The parietal pericardium contains the large arteries supplying blood to the heart wall, and the larger venous tributaries carrying blood from the heart wall. The visceral and parietal pericardial layers are separated by a pericardial cavity, which contains about 20–50 mL of pericardial fluid produced by the visceral layer (Figure 28.1) (3–7).
Mediastinal lymphadenopathy: a practical approach
Published in Expert Review of Respiratory Medicine, 2021
Hariharan Iyer, Abhishek Anand, PB Sryma, Kartik Gupta, Priyanka Naranje, Nishikant Damle, Saurabh Mittal, Neha Kawatra Madan, Anant Mohan, Vijay Hadda, Pawan Tiwari, Randeep Guleria, Karan Madan
The International Thymic Malignancy Interest group (ITMIG) classification divides the mediastinum into three compartments viz. prevascular, visceral, and paravertebral. The prevascular space has the same boundaries as the anterior part of inferior mediastinum, but it extends superiorly to the thoracic outlet level. It consists of the thymus, left brachiocephalic vein and lymph nodes. The visceral compartment is behind the anterior fibrous pericardium. It extends posteriorly till an imaginary plane passing from each thoracic vertebra at a point 1 cm behind the anterior border of the central body of the vertebra. It contains heart, ascending aorta, arch of the aorta and descending aorta, superior vena cava, pulmonary arteries, trachea, esophagus, thoracic duct and lymph nodes. Posterior to this imaginary vertical plane lies the paravertebral compartment. This compartment contains the thoracic spine and paravertebral soft tissue [6]. The intra-thoracic lymph nodes are distributed in all of these compartments (Figure 1A).
Pericardial Anatomy, Interventions and Therapeutics: A Contemporary Review
Published in Structural Heart, 2021
Reza Reyaldeen, Nicholas Chan, Saberio Lo Presti, Agostina Fava, Chris Anthony, E. Rene Rodriguez, Carmela D. Tan, Walid Saliba, Paul C Cremer, Allan L. Klein
The pericardium is a dual-layered flask-shaped fibroserous sac enveloping the heart and proximal great vessels with a potential space created by the parietal and visceral layers (Figure 1). The outer fibrous layer is contiguous with the great vessels superiorly and the diaphragm inferiorly. Anteriorly, the pericardium is related to the sternum by the sternopericardial ligaments. Laterally, the pericardium is associated with the parietal pleura, and posteriorly it remains in proximity to the bronchi, esophagus and descending thoracic aorta.1These central attachments help to maintain the heart’s position within the thorax. The fibrous pericardium is the tough outermost layer of connective tissue adjoining adjacent intrathoracic structures and defining the boundaries of the middle mediastinum, while the serous pericardium is thin and consists of the parietal and visceral (also known as the epicardium) layers. The parietal serosal component forms the inner surface of the fibrous pericardium, while the epicardium directly adheres to and encases the heart. Between the visceral pericardium and the myocardium are variable amounts of fat, which is most prominent along the atrioventricular and interventricular grooves, and acute angle of the right ventricle.1Importantly, the visceral fat contains coronary vasculature, lymphatics and nerves. The serosal layers create a narrow space between them called the pericardial cavity, which contains a small amount of serous lubricating fluid that permits the relatively uninhibited movement of the heart.2,3 Typically, this space may be occupied by up to 50 mL of fluid and variable amounts of epi/pericardial fat.4
Percutaneous pericardial access for electrophysiological studies in patients with prior cardiac surgery: approach and understanding the risks
Published in Expert Review of Cardiovascular Therapy, 2019
Ammar M. Killu, Samuel J. Asirvatham
The target for access, the pericardial cavity, is a ‘virtual’ space bound by the parietal and visceral (providing the shiny appearance to the epicardium) layers of the serous pericardium, which are continuous with one another (Figure 1). Within the space is approximately 10–15 milliliters of lubricant serous fluid. The parietal layer adjoins with the fibrous pericardium. The pericardial lining reflects around the great vessels (pericardial reflection) and is posteriorly related to the bronchi, esophagus, descending aorta and medial surface of the lung.