Pericardium Anatomy and Pathology

Question 1

What are the layers of the pericardium?

Answer 1

Visceral

Parietal

Fibrous (continuous with vessels, sternum and diaphragm)

Question 2

What are the symptoms of a large effusion?

Answer 2

Haemodynamic instability

Dysphagia

Dysopnea

Hiccups

Question 3

What are the functions of the pericardium?

Answer 3

1. Protection
2. Stability
3. Lubrication
4. Prevents excessive dilatation

Question 4

Where does pericardium referred pain appear?

Answer 4

Shoulder

C3,C4,C5

Phrenic Nerve

Question 5

What does a pericardial effusion look like on an ECG?

Answer 5

1. Widespread low activity
2. Tachycardia
3. Electrical alternans (different height QRS complexes)

Question 6

What does a pericarditis look like on an ECG?

Answer 6

Widespread ST elevation

Question 7

What is pulsus paradoxus?

Answer 7

This is the loss of a pulse which is exaggerated in pericardial effusion:

1. Breathing in lowers pressure and RV flow increases. This pushes and lowers volume in LV
2. Less blood released (exaggerated in effusion)
3. Pulse lost

SINUS ARRHYTHMIA