By the end of this chapter the student will be able to:
Identify the role of the pericardium in the function of the heart.
Recognize the symptoms associated with pericardial disease.
Identify the common EKG abnormalities in pericarditis.
Recognize the differences in symptoms between slowly and rapidly developing pericardial effusions.
Describe the treatment of pericarditis.
The pericardium has a unique role in the cardiovascular system, acting as a protective membrane around the heart, where abnormalities in its structure and function can lead to a wide range of cardiovascular and systemic symptoms. These develop either gradually or quite quickly depending on the underlying pathology, from chest pain which can be a cause of discomfort to the patient, to life threatening, as in the case of pericardial tamponade (ie, a condition in which the accumulation of fluid in the pericardial sac results in a compression of the chambers of the heart, ultimately leading to hemodynamic collapse).
This chapter will briefly introduce the reader to the anatomy and morphology of the pericardium and the effect of various diseases specific to the pericardium as well as systemic diseases that affect the pericardium and hamper its functions and the range of symptoms these diseases cause. The treatment of pericardial disease is also discussed at the end of this chapter.
The reader is encouraged to review the Suggested Readings references to further explore the pericardium and its various diseases and their symptoms.
The pericardium is comprised of 2 membranes with a space between them that contains 15 to 20 mL of fluid. The outer layer is fibrous in nature and is known as the parietal layer. The inner layer is serous and is known as the visceral layer. It is this inner layer that is attached to the outer surface of the heart. The pericardial fluid is an ultra-filtrate of plasma and is secreted by the parietal pericardium (Fig. 15.1).
A. Coronary section through the thorax. B. Layers of the pericardial sac. C. Anterior (sternocostal) surface of the heart. D. Posterior (base) and inferior (diaphragmatic) surface of the heart. E. Coronary grooves (anterior view). F. Coronary grooves (posterior view). (Reproduced, with permission, from Morton DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy. New York, NY: McGraw-Hill; 2011.)
The function of the pericardium is to prevent overexpansion of the cardiac chambers, to keep the heart in its anatomic location relative to the other organs in the chest cavity, and to prevent the direct spread of infection to the heart from nearby structures.
Classification of Pericarditis
Pericarditis can broadly be classified according to its clinical presentation or according to the underlying etiology; namely, infectious, ...