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THE HEART AND PERICARDIUM Aaron CampbellLEARNING OUTCOMES - PERICARDIUM 1. Describe the structure of the pericardium 2. Describe the location and structure of the fibrous and visceral pericardium 3. Describe the location of the pericardial cavity/space PERICARDIUM STRUCTURE • FIBROSEROUS MEMBRANE • Covers heart and beginning of great vessels • 2 Layers – Fibrous and Serous Pericardium • Serous further divided into parietal and visceral “Fart Police Smell Villains” Two layers of Serous pericardium separated by Serous fluid in pericardial Space PERICARDIAL LAYERS FIBROUS SEROUS • Tough, prevents overfilling • Parietal = Glistening, REFLECTED onto the heart at the great vessels as the VISCERAL layer • Continuous with central tendon inferiorly and tunica adventitia superiorly • Visceral = EPICARDIUM of heart wall, continuous with parietal layer at bases of great • Internal surface lined by parietal layer of serous vessels pericardium. • Attached to sternum via STERNOPERICARDIAL ligamentsSEROUS PERICARDIUM Potential space between visceral and parietal pericardium, contains fluid to reduce friction on beating of heart Serous pericardium produces the fluid CLINICAL RELEV ANCE Pericarditis •Inflammation of SEROUS pericardium •Chronic --> CALCIFICATION of pericardial sac •Increase in serous fluid in pericardial space (Pericardial Effusion) •Pericardial fluid accumulates excessively, can COMPRESS the atria as volume of mediastinum reduced so reduced filling (CARDIAC TAMPONADE) Cardiac Tamponade •Can also occur following penetration of the heart, as blood leaks into pericardial space (Haemopericardium) (eg stabbing, iatrogenic, weakened heart muscle area post-MI) •SVC etc becomes enlarged •Echo can detect pericardial fluid + PERICARDIOCENTESIS Drain space with needle Inserted left of XIPHOID process at 45-degree angle supero-posteriorly (avoid lungs as travels through CARDIAC NOTCH)PERICARDIOCENTESIS https://youtu.be/wKYWhutqzygLEARNING OUTCOMES - HEART 1. List and describe the layers of the heart wall 2. Describe the location of and identify the chambers of the heart, valves and the great vessels 3. Describe and identify the location of the transverse and oblique pericardial sinuses 4. Describe and identify the surface projections of the heartREMEMBER! Visceral PericardiumHEART CHAMBERS, V ALVES & GREAT VESSELSHEART SURFACESHEART VALVESHEART VALVES PERICARDIAL SINUSES (RECESS OF SEROUS PERICARDIUM) Transverse • Passage within the pericardial cavity • Runs between Aorta, Pulmonary trunk & SVC, IVC, pulmonary veins (Great Vessels) • Arteries anterior, Veins posterior Used to pass instruments in to ligate/clamp vessels during surgery Can insert bypass machine tubes after making ant pericardial incision PERICARDIAL SINUSES (RECESS OF SEROUS PERICARDIUM) Oblique • Pocket-like recess in pericardial cavity, posterior to the base of heart • Caused by reflection onto pulmonary veins • Bounded laterally by the pericardial reflections surrounding pulmonary veins and IVC (on rt side) • Bounded posteriorly by pericardium overlying the OESOPHAGUSQ/ When do the A-V valves close during the cardiac cycle? A. when pressure inside the ventricles is at its lowest B. when pressure inside the atria is greater than that inside the ventricles C. when ventricular pressure exceeds that of the atria D. when pressure is greater in the aorta than in the left ventricleQ/ When do the A-V valves close during the cardiac cycle? A. When pressure inside the ventricles is at its lowest B. When pressure inside the atria is greater than that inside the ventricles C. When ventricular pressure exceeds that of the atria D. When pressure is greater in the aorta than in the left ventricleQ/ Which membrane is closest to the heart muscle? A. Pericardial Sac B. Fibrous Pericardium C. Parietal Pericardium D. Visceral Pericardium E. Parietal PleuraQ/ Which membrane is closest to the heart muscle? A. Pericardial Sac B. Fibrous Pericardium C. Parietal Pericardium D. Visceral Pericardium E. Parietal Pleura THANKS! ANY QUESTIONS? acampbell98@qub.ac.uk