Functions of the Cardiovascular System
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal in Principles of Physiology for the Anaesthetist, 2020
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.
Cardiovascular physiology
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal in Principles of Physiology for the Anaesthetist, 2015
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.
Bunny Suit
R. Annie Gough in Injury Illustrated, 2020
As we methodically carried out the steps of the post, the coroner stopped cold. “Wait a minute,” she said, staring me down, “What did we forget?” She stared at her hands, confused. She verbally repeated the steps we had completed: Toxicology samples taken, skin incision, rib cage removed, initial inspection of the thoracic cavity. She went to cut the pericardial sac and lift the apex of the heart to withdraw blood for the DNA lab. She looked again, forceps in hand, lifting the heart. Where was the pericardial sac? Why didn't we cut the pericardial sac? As it turned out, there was no pericardial sac. This young man had survived 27 years without the fibrous envelope around his heart. Known for secreting pericardial fluid and lubricating the heart, the pericardial sac allows the heart to pump and turn with minimal friction. Considering the vital importance of your heart, this was a significant anatomical structure to be missing. As we removed the lungs, it was clear his heart was quite enlarged, large enough to end his life. The conclusion was that this was a natural death; a heart attack in the spice factory. No homicide. No vicious smothering in chili powder. No Colonel Mustard in the library with a candlestick. The policemen sighed with disappointment, pulled off their masks, and left the autopsy suite.
Therapeutic advances in cardiac targeted drug delivery: from theory to practice
Published in Journal of Drug Targeting, 2021
Cuican Li, Muhammad Naveed, Kashif Dar, Ziwei Liu, Mirza Muhammad Faran Ashraf Baig, Rundong Lv, Muhammad Saeed, Chen Dingding, Yu Feng, Zhou Xiaohui
The pericardium is a double-layered sac that wraps around the heart and blood vessels [60]. The space between the parietal and visceral pericardium is called the pericardial cavity that contains pericardial fluid. Intrapericardial injection is mostly completed by pericardiocentesis, and the drugs are stored in the pericardial cavity after intrapericardial injection to achieve the purpose of TDD. Pericardiocentesis is typically used in patients with pericardial effusion and is performed via the subxiphoid route, where a small amount of contrast medium is injected into the pericardium by a puncture needle [61]. For better safety, efficacy, and accuracy in clinical applications, many advanced scientific and technological tools were developed to assist in completing pericardiocentesis [62,63]. The development of these techniques serves as a basis for intrapericardial injection.
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
Distinct histologic changes are often noted in the setting of pericardial pathology. For instance, in the progression of pericarditis, the pathophysiologic process consists of first deposition of fibrinous material and recruitment of inflammatory cells, then disintegration of mesothelial cells, followed by organization with ingrowth of fibroblasts and neovascularization.8 The main response to pericardial injury is the production of pericardial fluid, which often manifests as effusion and is readily identified by echocardiography. Inflammation can be detected by more advanced cardiovascular imaging techniques, particularly cardiac MRI and to a lesser extent CT, with pericardial neovascularization in the setting of pericarditis correlating with delayed pericardial hyperenhancement on MRI.9 Healing through organization can result in the formation of adhesions between the parietal and visceral pericardial layers, disrupting and obliterating the pericardial cavity space, which can lead to eventual constriction. Calcification represents an end-stage response to repeated and progressive pericardial injury.1
Acute purulent pericarditis treated conservatively with intrapericardial fibrinolysis and intrapericardial and systemic antibiotics
Published in Baylor University Medical Center Proceedings, 2021
Mahmoud Abdelnabi, Abdallah Almaghraby, Yehia Saleh, Alyaa El Sayed, Judy Rizk
Purulent pericarditis is typically present as an acute illness characterized by high-grade fever, tachycardia, cough, and less commonly chest pain. In the postoperative setting, most patients with purulent pericarditis also have signs of mediastinitis or sternal wound infection. Cardiac tamponade may also occur.3S. aureus is the most common implicated pathogen, while Streptococcus pneumoniae is the most common organism in the setting of direct extension of an intrathoracic infection. Other causes include gram-positive organisms, fungi, and Mycobacterium tuberculosis. Polymicrobial infections are uncommon.4–6 Pericardial fluid analysis including chemical testing (for protein and glucose content as well as white cell count), microscopy (gram stain, acid-fast stain, and fungal stain), and culture and sensitivity is the mainstay for the diagnosis of purulent pericarditis.7
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- Pericardial Effusion
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- Pericardium