1. Anatomy
    2. 1. Mediastinum
    2. The Heart Development
    3. Pericardium
    4. Features of the Heart
    5. Arterial Supply of Heart
    6. Venous Drainage of the Heart
    7. Conducting System of Heart
    8. Nervous System of Heart
    9. Foetal Circulation and Changes at Birth
    10. Microscopic Structure of Heart
    11. Arteries
    12. Arch of Aorta
    13. Descending Thoracic Artery
    14. Abdominal Aorta
    15. Subclavian Artery
    16. Axiallary Artery
    17. Internal Thoracic Artery
    18. Brachial Artery
    19. Radial Artery
    20. Ulnar Artery
    21. Palmar Arches
    22. External Iliac Artery
    23. Internal Iliac Artery
    24. Femoral Artery
    25. Popliteal Artery
    26. Posterior Tibial Artery
    27. Anterior Tibial Artery
    28. Dorsalis Pedia Artery
    29. Common Carotid Artery
    30. External Carotid Artery
    31. Internal Carotid Artery
    32. Veins
    33. Internal Jugular Vein
    34. External Jugular Vein
    35. Superior Venacava
    36. Inferior Venacava
    37. Brachiocephali vein
    38. Subclavian vein
    39. Axillary vein
    40. Cephalic vein
    41. Basilic vein
    42. Azygous vein
    43. Hemiazyous vein
    44. Accessory Hemiazyoug Vein
    45. Internal Hemiazygous Vein
    46. Internal Iliac Vein
    47. Femoral Vein
    48. Popliteal Vein
    49. Long Saphenous Vein
    50. Small or Short Saphenous Vein
    51. Hepato-portal System
    52. Lymphatic System
    53. Spleen
    54. Thymus
    55. Thoracic duct
  2. Pharmacology
    3. 56. Congestive Heart Failure
    57. Therapy of Arrhythmiasis
    58. Angina pectoris
    59. Therapy of Hypertension
    60. Therapy of Shock
    61. Haemostatic Agents
    62. Therapy of Thromboembolic Disorder
    63. Thrombolytic or Fibrinolytics
    64. Antifibrinolytics
    65. Antiplatelet Drugs
    66. Therapy of Iron Deficiency Anemia
    67. Therapy of Megaloblastic Anaemia
    68. Hypolipidemic Drugs and Plasma Expanders
  3. Physiology
    4. 69. Properties of Myocardial Cells
    70. Heart - A Mechanical Pump
    71. Cardiac Cycle
    72. Electrocardiogram (ECG)
    73. Cardiac Output (CO)
    74. Haemodynamics of Circulation
    75. Heart Sounds
    76. Arterial Pulse
    77. Blood pressure
    78. Regional circulation
    79. Cardiovascular chanes during exercise
    80. Edema Dropsy of fluid retention
    81. Shock
    82. Hematology
  4. Pathology
    5. 83. Anaemia
    84. Hypertension
    85. Hypertensive Heart Disease
    86. Ischemic Heart Disease
    87. Angina pectoris
    88. Myocardial infarction
    89. Rheumatic Fever and Rheumatic Heart Disease (RHD)
    90. Acute Pericarditis
    91. Myocarditis
    92. Infective Endocarditis (IE)
    93. Congenital Heart Disease
    94. Cardiomyopathies
    95. Arteriosclerosis
    96. Atherosclerosis
    97. Inflammatory Disease of Blood Vessels
    98. Aneurysms and Dissection
    99. Congestive Heart Failure
    100. Iron Deficiency Anaemia
    101. Megaloblastic anaemia
    102. Pancytopenia
    103. Leucocytosis and Leucopenia
    104. Aplastic anaemia
    105. Haemolytic anaemia
    106. Hereditary Spherocytosis
    107. Haemoglobinipathies
    108. Thalassemia syndrome
    109. Sickle Cell Disease
    110. Leukaemia
    111. Leukemoid reaction
    112. Lymphadenitits
    113. Hodgkin lymphoma
    114. Non-hodgkin lymphoma
    115. Myeloproliferative disorders
    116. Myelofibrosis
    117. Multiple myeloma
    118. Bleeding disorders
    119. Coagulation disorders
    120. any
    121. Blood grouping
  5. Microbiology
    6. 122. Introduction of Blood borne infections
    123. Infective Endocarditis
    124. Brucella
    125. Rickettsiae
    126. Leishmania donovani
    127. Plasmodium
    128. Wuchereria bancrofti
  6. Biochemistry
    7. 129. Metabolism in Blood Cells
    130. Iron metabolism
    131. Haemoglobin
    132. Lipoprotein metabolism
    133. Biochemical aspect of MI
Anatomy
3. Pericardium
INTRODUCTION
  1. The pericardium is a fibroserous sac which encloses the heart and the roots of the great vessels.
  2. It is of greaat
POSITION
  1. Lies in Middle mediastinum
  2. Posterior to sternum and 2nd to 6th costal cartilages.
  3. Anterior to T5 and T8 vertebrae.
FUNCTIONS
  1. Prevents over-expansion of heart when blood volume increases.
  2. Limits the heart's movements.
  3. Serves as lubricated container in which heart can contract and relax smoothly.
  4. Acts as a shock absorber with the help of the fluid filled in pericardial cavity.
DIVISION
Fibrous pericardium
  1. Fibrous pericardium is the outer layer of pericardium.
  2. It is a sac made of tough connective tissue.
  3. It is cone shaped bag with the apex directed above.
  4. It defines the boundaries of the middle mediastinum.
  5. It is pierced by following blood vessels
    1. Ascending aorta
    2. Superior venacava
    3. Inferior venacava
    4. Right and Left pulmonary arteries
    5. 4 pulmonary veins
  6. Attachments
    7. ◈ Superiorly: Continuous with adventitia of the great vessels and also pre-tracheal fascia.
    ◈ Inferiorly: Attached to central tendon of diaphragm and a small muscular part of its left side. (Septum transversum)
    ◈ Anteriorly: Attached to posterior surface of sternum by superior and inferior sternopericardial ligaments. (These ligaments help to retain the heart in its position in cavity.)
    ◈ Laterally: Phrenic nerve with its accompanying pericardio-phrenic vessels passes through the fibrous pericardium.
  7. Below the left 4th costal cartilage, pericardium comes in direct contact with the left half of lower area of the body of sternum due to cardiac notch.
    • •
      This is important site for Paracentesis (Aspiration of pericardial fluid).
Serous pericardium
  1. It is thin inner layer.
  2. The parietal and visceral layers of serous pericardium are continuous at the roots of the great vessels.
  3. The reflections of serous pericardium occurs in two locations.
    1. One surrounding the arteries (the aorta and the pulmonary trunk).
    2. The second is surrounding the veins (the SVC, IVC and Pulmonary veins).
Parietal pericardium
  1. Lines the inner surface of pericardium.
Pericardial cavity
  1. The narrow space between the parietal and visceral layer of serous pericardium is called Pericardial cavity.
  2. It is lined by mesothelium.
  3. It contains 150ml of Pericardial fluid.
Visceral pericardium/ Epicardium
  1. It adheres to the heart and forms its outer covering.
Contents
  1. Ascending aorta
  2. Pulmonary trunk
  3. Venae cavae
  4. Pulmonary veins
Differences between Parietal and Visceral pericardium
Parietal pericardium
Visceral pericardium
It lines the fibrous pericardium.
It is closely applied to heart except at the grooves of heart where it is separated from heart by blood vessels.
It is reflected at the root of blood vessels to become continuous as visceral pericardium.
It develops from Somatopleuric layer of mesoderm.
It develops from Splanchnopleuric layer of mesoderm.
It is innervated by Somatic nerve.
It is innervated by autonomic nerve.
It is pain sensitive.
It is pain insensitive.
CONTENTS
  1. Heart with cardiac vessels and nerves
  2. Ascending aorta
  3. Pulmonary trunk
  4. Lower half of the superior vena cava
  5. Terminal part of the inferior vena cava
  6. The terminal parts of the pulmonary veins
INNERVATION
Fibrous and Parietal pericardium
  1. Phrenic nerve
Visceral pericardium
Parasympathetic nerves
Vagus nerve
Sympathetic nerves
Coronary plexus.
BLOOD SUPPLY
Arterial supply
Fibrous and Parietal pericardium
  1. Internal thoracic arteries
  2. Musculophrenic arteries
  3. Pericardiophrenic arteries
  4. The descending thoracic aorta
Visceral pericardium
  1. Coronary arteries
Venous drainage
Tributaries of the azygous system and internal thoracic veins.
SINUSES OF PERICARDIUM
Transverse sinus of pericardium
  1. The transverse sinus is a horizontal gap betweent the arterial and venous ends of the heart tube.
    1. Arterial end encloses the aorta and pulmonary trunk.
    2. Venous end encloses the venae cavae and pulmonary veins.
  2. It develops from degeneration of the central part of Dorsal mesocardium.
Boundary
Anterior
  1. Ascending aorta
  2. Pulmonary trunk
Inferior
  1. Left atrium on each side
Posterior
  1. Superior venacava
Introduction
Definition
The passage between the two, arterial tube and venous tube of epicardium is called Transverse sinus of pericardium
Development
Developed from Central part of dorsal mesocardium
Oblique sinus
  1. The oblique sinus is a narrow gap behind the left atrium of heart.
  2. The oblique sinus is also called as 'Cul-de-sac'.
  3. It is developed due to rearrangement of veins at the venous end.
Boundary
Anterior
  1. Left atrium
Posterior
  1. Parietal pericardium
  2. Oesophagus
Left side
  1. Left pulmonary veins
Right side
  1. Right pulmonary veins
Superior
  1. Reflection of visceral pericardium along upper margin of left atrium.
Inferior
It is open
Clinical significance
Permits pulsations of the left atrium to take place freely.
Clinical Correlates
Pericardial effusion/ Cardiac tamponade
  1. Collection of fluid in the pericardial cavity is referred to as pericardial effusion or cardiac tamponade.
  2. The fluid compresses the heart and restricts venous filling durind diastole thus reducing the reducing cardiac output.
  3. Pericardial effusion can be drained by puncturing the left fifth or sixth intercostal space just lateral to the sternum, or in the angle between the xiphoid process and left costal margin, with the needle directed upwards, backwards and to the left.
Ortner's syndrome
In mitral stenosis, left atrium enlarges and compresses the oesophagus causing Dysphagia.
Pericarditis
  1. Inflammation of pericardium is called as Pericarditis.
  2. It is often confused with MI where both shows Clavicular referred pain.
  3. There is Pericardial Rub sound in paricarditis which is not shown in MI.
During heart surgery, the ligature is passed through the transverse sinus around aorta and the pulmonary trunk.