The fibrous pericardium is the tough, cone-shaped outer bag of dense connective tissue that surrounds the heart. Its base is fused to the central tendon of the diaphragm, and its top blends with the outer walls of the great vessels. It stretches very little, which protects the heart from sudden overdistension.
| Location | Middle mediastinum, attached below to the central tendon of the diaphragm (pericardiacophrenic ligament) and in front to the back of the sternum by the sternopericardial ligaments. |
|---|---|
| Parts |
|
| Nerve Supply | Phrenic nerves |
| Blood Supply | Pericardiacophrenic arteries; Musculophrenic arteries |
Holds the heart in position, limits acute dilation of the chambers, and protects the heart from mechanical injury and spread of infection.
Because it is inelastic in the short term, rapid accumulation of even 100-200 mL of fluid can cause tamponade, while slow accumulation allows the sac to stretch and hold much more. The phrenic nerves run along its outer surface, where they can be injured during cardiac surgery. Congenital partial absence of the pericardium is rare and can allow parts of the heart to herniate.
Rising pressure in the inelastic sac compresses the heart and prevents filling. It can follow trauma, cardiac surgery or rapidly forming effusions.
A rare defect, usually on the left, that is often harmless. Partial defects can trap part of the heart and cause chest pain.
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