Pericardium – Function, Anatomy and Diseases
The pericardium is the protective sac surrounding the heart. It stabilizes the position of the heart within the chest and shields it from infection and mechanical injury.
Things worth knowing about "Pericardium"
The pericardium is the protective sac surrounding the heart. It stabilizes the position of the heart within the chest and shields it from infection and mechanical injury.
What Is the Pericardium?
The pericardium (also called the pericardial sac) is a double-walled fibrous sac that encloses the heart. It consists of two main layers: the outer fibrous pericardium and the inner serous pericardium. The serous pericardium is further divided into two layers: the parietal layer (lining the inside of the fibrous sac) and the visceral layer (also known as the epicardium), which adheres directly to the surface of the heart.
Between the two serous layers lies the pericardial cavity, which normally contains approximately 15 to 50 milliliters of serous fluid. This fluid acts as a lubricant, reducing friction as the heart beats.
Functions of the Pericardium
- Mechanical protection: The pericardium shields the heart from external trauma and injury.
- Anatomical anchoring: It fixes the heart within the mediastinum (the central compartment of the chest), preventing excessive movement.
- Infection barrier: The pericardium acts as a barrier against the spread of infection from neighboring structures such as the lungs and esophagus.
- Friction reduction: Pericardial fluid allows the heart to move smoothly with each heartbeat.
- Pressure limitation: The fibrous pericardium limits acute overdistension of the heart during sudden increases in blood volume.
Diseases of the Pericardium
Pericarditis (Inflammation of the Pericardium)
Pericarditis is an inflammation of the pericardium, most commonly caused by viral infections (e.g., Coxsackievirus, influenza), bacteria, autoimmune disorders, or as a complication following a heart attack. Typical symptoms include sharp chest pain that worsens when lying down or breathing deeply, and fever. Diagnosis is based on ECG findings, echocardiography, and laboratory markers (CRP, troponin).
Pericardial Effusion
A pericardial effusion occurs when excess fluid accumulates within the pericardial cavity. It can result from pericarditis, heart failure, kidney failure, malignancy, or following cardiac surgery. Small effusions are often asymptomatic; large effusions may cause shortness of breath and a feeling of pressure in the chest.
Cardiac Tamponade
Cardiac tamponade is a life-threatening emergency in which the accumulation of fluid or blood within the pericardial sac compresses the heart, impairing its ability to fill adequately. Classic signs include low blood pressure, distended neck veins, and muffled heart sounds -- known as Beck's triad. Immediate treatment involves draining the fluid via pericardiocentesis (needle drainage).
Constrictive Pericarditis
Constrictive pericarditis develops when the pericardium becomes scarred and calcified following chronic inflammation, permanently restricting the filling of the heart. Treatment in severe cases requires surgical removal of the pericardium, known as pericardiectomy.
Diagnosis of Pericardial Diseases
- Echocardiography (cardiac ultrasound): The primary imaging method for detecting pericardial effusions and structural changes.
- ECG (electrocardiogram): Characteristic widespread ST-segment elevation is seen in acute pericarditis.
- CT and MRI of the chest: Provide detailed assessment of pericardial thickness and morphology.
- Laboratory tests: Inflammatory markers such as CRP and white blood cell count; troponin to rule out myocardial involvement.
Treatment of Pericardial Diseases
Treatment depends on the underlying cause. Acute pericarditis is primarily managed with anti-inflammatory drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin, combined with colchicine. Bacterial pericarditis requires antibiotic therapy. Symptomatic pericardial effusions may be drained by pericardiocentesis. Severe constrictive pericarditis is treated surgically with pericardiectomy.
References
- Adler Y. et al. - 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. European Heart Journal, 36(42): 2921-2964.
- Imazio M. et al. - Colchicine in addition to conventional therapy for acute pericarditis. Annals of Internal Medicine, 2013.
- Lilly L.S. (ed.) - Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty. 6th edition, Wolters Kluwer, 2016.
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