1 pericardium - mbbs

8/6/2019 1 Pericardium - Mbbs

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PERICARDIUM

MBBS 1, SEMESTER 2

A. MWAKIKUNGA


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Learning Obj ectives

Descri be the structure of the f ibrous and ser ous pericardiumState the f uncti on of the pericardiumName the bloo d and nerve su pply to the pericardiumReca ll the link between the innervati on of the pericardium and dia phragm with pain in the sh oulder regi on (an exam ple of re f erred pain )App reciate the po siti on of the transverse and obl ique sinuses of the ser ous pericardium and wh y the y are im po rtant in clinica l practice

Def ine pericarditis and cardiac tam po nade and brie flyex plain their causes


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PERICARDIUM

PERICARDIUM - double - wa lled f ibroser ous sac enc losing heart & roo ts of its great vesse ls

vena cavae , p u lm onar y veins , p u lm onar ytrunk , a ortaATTACHMENTS

Sternum po st by stern op ericardia l ligaments

Adventitia of great vesse lsCentra l tend on of dia phragm bypericardiac op hrenic ligament


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Arch of aorta

Left phrenic ner

Left lung root

Leftbrachiocephalicvein

Diaphragm

Trachea

Apex offibrouspericardium

Base of the fibrous pericardium

Left vagus nerv


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COMPONENTS OF THE PERICARDIUM

Fibrous pericardium (FP) - su per f icia l p art of sac

Ser ous pericardium (SP) - double layered dee p to FP


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STRUCTURE OF

THEPERICARDIUM


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FIBROUS PERICARDIUM

CT - tough , dense collagen ous connective tissue

PROTECTS HEART& limits its distenti oncann ot se parate f ib rous layer f rom parieta l

ser ous pericardium - this uni on gives the sac its distinctive toughness

PREVENTS OVERFILLING with bloo d


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FIBROUS PERICARDIUM CONTD

EXTENSIONSto aorta , SVC, pulm onar y trunk & 4 p u lm veins

Derived f rom em bryolo gic pleur op ericardia lfolds that contain bo dy wa ll mesench yme which is added to somatic mes oderm


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FIBROUS PERICARDIUM CONTANT - se parated f rom th oracic wa ll by l ungs & attach to sternum by 2 stern op ericardia lligaments

POST RELATIONS - b ronchi , es op hagus , aorta & lungsLAT - pl eura l coverings

INF - anch ors heart to dia phragm - centra ltend onSUP - anch ors heart to adventitia of great vesse ls


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SEROUS PERICARDIUM

PARIETAL LAYER

Derived f rom somatic mes oderm & ass ociated with the bo dy wa ll:

Lines interna l sur f ace of FP

Turns inf & continues over ext heart sur f ace as viscera l layer

Sup - surr ounds arts , aorta & p trunk Po st - surr ounds SVC, IVC& p veins


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SEROUS PERICARDIUM CONTVISCERAL LAYER OR EPICARDIUM

Derived f rom viscera l mes oderm

Super f icia l & part of heart wa ll

PERICARDIALCAVITYBetween tw o layers of ser ous mem brane

Has ser ous fluid that lubricates m ob ile heart


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SEROUS PERICARDIALSINUSESPARIETALcont . w viscera l layers at roo ts of great vesse ls - re flecti ons (1)su p - surr ounds arts , aorta & p trunk (2)po st - surr ounds veins ,SVC& IVC& pul. veins .

REFLECTIONSsurr ound veins , J-sha ped OBLIQUE P SINUS - sac within J po st to LA

es op hagus is a po steri or re lati on TRANSVERSE P SINUSpassage between tw o

ser ous pericardia l re flecti ons :po st to asc . aorta & p trunkant to SVC, & su p to LA


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SEROUS

PERICARDIALSINUSES


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T ransverse pericardial sinus


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BLOOD & NERVE SUPPLY TO THEPERICARDIUM

ARTERIALSUPPLYBranches of b ronchia l, es op hagea l, su peri or

phrenic arteries , Interna l th oracic ,pericardiac op hrenic , muscu lop hrenic , & inf phrenic arteries

coronar y arteries su pply the e p icardium

VENOUS DRAINAGEAzygos, interna l th oracic & inf p hrenic vs .


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BLOOD & NERVE SUPPLY TO THE

PERICARDIUM CONTDNERVE SUPPLY- vagus & phrenic nerves

PAIN FROM PARIETALPERICARDIUM

Carried in phrenics; 'p ain ' re f erred to skin abo ve sh oulder (C3, C4, C5); neck

these cutane ous cervica l sp ina l nerves share a comm on origin with the phrenic nerve


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C7

C7

C6

C5

C4

C8Phrenic nerves are branches of the cervical plexus ( C3,4,5) sensory supply to the fibrous and parietal pericardium , pleura and motor supply to the diaphragm ( C4 supplies skinover shoulder

Pain from pericardium is referred on skin over the shoulder


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CLINICALCORRELATES

SURGERYWhen pericardium is op ened , f inger placed in

the transverse sinus se parates arts f rom veins

Hand placed under apex of heart & m oved su peri orly slips int o the obl ique sinus


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CLINICALCORRELATES CONTD

PERICARDITIS

Might follo w bacteria l p neum onia

Hinders ser ous fluid producti on

Roughens ser ous mem brane sur f aceCreates rust ling heart sound - f ricti on ru b

Causes centra l chest pain worse on ins p irati on & re lieved by sitting fo rward


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CLINICALCORRELATES CONTD

CARDIAC TAMPONADE

Fluid com pressi on in pericardia l cavit y due toindistensi ble f ib rous com po nent

hem op ericardium - bleeding f rom trauma or a ortic dissecti on (a tear in the end othe lium a llows bloo d totrack between tunica intima and media l layers)

Treatment - drainage of fl uid with a syringe

(pericardi ocentesis ) - pericardia l ta pinsert need le thr ough th oracic wa ll upward to l e f t of xipho id process towards the inf eri or ang le of the le f t sca pula - assured of no t p iercing pleura l mem branes


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1 pericardium - mbbs

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