The pericardium is the double-walled sac that encloses the heart and the roots of the great vessels. It has a tough outer fibrous layer and an inner serous layer, which is itself folded into parietal and visceral layers with a thin film of fluid between them. This arrangement lets the heart beat with almost no friction.
| Location | Middle mediastinum, behind the sternum and costal cartilages, fused below with the central tendon of the diaphragm and above with the outer coat of the great vessels. |
|---|---|
| Parts |
|
| Nerve Supply | Phrenic nerves (sensory, pain referred to the shoulder); Vagus nerves; Sympathetic trunks |
| Blood Supply | Pericardiacophrenic arteries (from the internal thoracic arteries); Musculophrenic arteries; Bronchial, oesophageal and superior phrenic arteries |
| Venous drainage |
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| Lymphatic drainage |
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Anchors the heart in the chest, limits sudden over-filling of the heart, lubricates its movements and acts as a barrier against spread of infection from nearby structures.
Fluid building up quickly in the pericardial sac can compress the heart (cardiac tamponade), even when the volume is small, because the fibrous layer cannot stretch quickly. Pericardiocentesis is commonly performed by a needle from below the xiphoid process. Pericardial pain is carried by the phrenic nerves and is often felt at the tip of the shoulder.
Compression of the heart by fluid or blood in the pericardial sac, causing low blood pressure, raised neck veins and muffled heart sounds. It needs urgent drainage.
Thickening and scarring of the pericardium that stops the heart filling properly. It may follow infection, radiotherapy or surgery and can require removal of the pericardium.
Inflammation of the pericardium, often viral, causing sharp positional chest pain. Return to sport is usually delayed until it has fully settled.
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