The epicardium is the outermost layer of the heart wall and is the same structure as the visceral layer of serous pericardium. It is a thin layer of flat mesothelial cells over connective tissue and fat. The main coronary arteries and veins run within or just beneath it.
| Location | Covers the outer surface of the heart and the roots of the great vessels, where it reflects to become the parietal layer of serous pericardium. |
|---|---|
| Parts |
|
| Nerve Supply | Cardiac plexus; Vagus nerves (parasympathetic, slows rate); Sympathetic cardiac nerves from cervical and upper thoracic (T1-T4) ganglia (raise rate and force) |
| Blood Supply | Coronary arteries and their epicardial branches |
| Venous drainage |
|
| Lymphatic drainage |
|
Gives the heart a smooth, lubricated outer surface that slides freely within the pericardial cavity, and supports and protects the coronary vessels and nerves.
Epicardial fat increases with obesity and is linked to coronary artery disease and atrial fibrillation. Because the coronary arteries are epicardial, bypass grafts are sewn onto them on the heart's surface. Some arrhythmias arise from the outer wall and are ablated from the epicardial side by a needle passed into the pericardial space.
Inflammation of the serous pericardium, including the epicardium. It causes sharp chest pain that eases on leaning forward and may produce a friction rub.
Excess fat around the heart associated with obesity and metabolic disease. It is linked to coronary atherosclerosis and atrial arrhythmias.
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