 A potential space is a is a double lining  Inner layer=visceral pericardium  Outer layer=parietal pericardium  Serous fluid in between acts as lubricant to prevent friction Pericarditis:  Inflammation, Neoplastic Disease, or Congenital Disorders  Constrictive or Acute  Leads to: o Pain o Exudate  Serous  pericardial effusion

9  Cardiac tamponade: rapid accumulation of exudate compresses the heart  Fibrous  friction rub; adhesions o ECG changes  Remember those things that cause cell injury and inflammation are the same culprits in pericarditis: o Infection (viral infections are most common cause of acute pericarditis) o Hypersensitivity o Autoimmune (rheumatoid arthritis and lupus) o Ischemia o Physical & Chemical agents (common after radiation to chest tumors) o Constrictive: scar tissue contracts and interferes with diastolic filling of heart—so at rest can’t relax ventricle to allow filling—from inflammation, radiation, or trauma—treat with surgery Disorders of Pericardium:  Disorders of Pericardium  Pericarditis: o Acute o Chronic o Constrictive  Major threat is compression of heart chambers  May have no s/s if small or growing  Limits preload because of increased intracardiac pressures—so low CO  Treat with anti-inflammatory or depends on cause Acute Pericarditis:  Inflammation of the pericardium of less than 2 weeks duration  May restrict the heart’s movement due to: o Serous exudate filling the pericardial cavity  pericardial effusion o Fibrous scar tissue making the pericardium stick to the heart  constrictive pericarditis  Manifestations Triad: o Chest Pain o Pericardial Friction Rub o ECG changes Pericardial Effusion :  Accumulation of fluid or blood in pericardial sac  Impairs venous return & ventricular filling  decreased CO  Etiologies: trauma, cardiac surgery, neoplasms  Can be complication of CABG  Major threat is compression of heart chambers  May have no s/s if small or slow growing—as long as pericardium can stretch and not constrict heart  Limits preload because of increased intracardiac pressures

10  Dx. With ECHO  Treat with aspiration or surgery  (if you do your DB on this concept you must expand it beyond this…) Cardiac Tamponade :  Increased intrapericardial pressure caused by pericardial effusion impairs venous return to the heart (decreases preload)  Clinical manifestations result from impaired ventricular filling resulting in decreased SV and ultimately decreased CO  Drop in BP with inspiration  Severe pericardial effusion  Dx with echocardiogram—quick, accurate, and noninvasive!  Pulsus paradoxus o Clinical indicator of cardiac tamponade o >10mmHg decrease in systolic BP during inspiration o On inhaling, the right ventricle fills with extra blood o Because the heart cannot expand fully when the right ventricle is overfilled, the left ventricle is compressed and cannot accept much blood o