Pericardium

What is the pericardium?

Your pericardium is a protective, fluid-filled sac that surrounds your heart and helps it function properly.

Your pericardium also covers the roots of your major blood vessels as they extend from your heart. These are known as your “great vessels,” and they include your:

• Aorta.
• Main pulmonary artery.
• Pulmonary veins.
• Superior and inferior vena cava.

What are the functions of the pericardium?

Your pericardium has several important functions. These include:

• Cushioning your heart from outside forces and pressure.
• Holding your heart in place.
• Keeping your heart from expanding too much and filling with too much blood.
• Protecting your heart from infections.
• Providing lubrication to reduce friction between your heart and surrounding tissues.

Where is the pericardium located?

Your pericardium is located in your chest, where it surrounds your heart. Your heart is located in the front of your chest, slightly to the left of your breastbone (sternum). If you have dextrocardia, your heart is slightly to the right of your breastbone.

What are the layers of the pericardium?

Your pericardium has two main layers:

• Fibrous pericardium: This is the tough, outermost layer of your pericardium. It’s made of connective tissue that prevents your heart from expanding too much. It attaches to your great vessels (at the top of your heart) and to the central tendon of your diaphragm (at the bottom of your heart). At the front of your chest, ligaments connect this layer to your breastbone.
• Serous pericardium: This is the inner layer of your pericardium. It’s actually made of two layers, described below. Your serous pericardium produces pericardial fluid that lubricates your heart as it beats.

Your serous pericardium is made of two layers:

• Parietal layer of the serous pericardium: This is the outer layer that’s firmly attached to your fibrous pericardium. There’s no space between them.
• Visceral layer of the serous pericardium: This is the innermost layer of your pericardium. It directly covers your heart and the roots of your great vessels. The portion that covers your heart is also known as your epicardium.

Your pericardial cavity is the space between the two layers of your serous pericardium. This space holds your pericardial fluid.

What conditions and disorders affect the pericardium?

Conditions and disorders that affect the pericardium include:

• Pericarditis: Inflammation of your pericardium. It’s usually acute but can also be chronic.
• Constrictive pericarditis: A condition in which your pericardium becomes too thick or stiff.
• Pericardial effusion: A buildup of fluid (more than there should be) in your pericardium.
• Cardiac tamponade: A dangerous condition that happens when fluid builds up and puts pressure on your heart. This outside pressure on the heart prevents it from filling properly.
• Pericardial cysts: Growths that may cause no problems but can sometimes put pressure on your heart or lungs.

What happens if the pericardium is damaged?

Normally, your pericardium is flexible and stretchy. It can easily expand with the heart as the heart fills up with blood and then contracts to pump the blood out to your body. Pericardial conditions and disorders prevent your heart from expanding as it should. As a result, your heart can’t fill and pump blood efficiently to the rest of your body. This can lead to dangerous complications, including heart failure and cardiogenic shock.

What are the symptoms of pericardial problems?

Symptoms depend on the specific condition but generally can include:

• Chest pain that may feel sharp or radiate to your arm, back or neck. The pain may get worse when you cough, swallow, breathe deeply or lie down flat.
• Dizziness or fainting.
• Dry cough.
• Fast heartbeat (tachycardia) or heart palpitations.
• Fatigue.
• Fever.
• Pain in your back, neck or shoulder.
• Shortness of breath (dyspnea).
• Swelling (edema) in your belly or lower legs.
• Trouble swallowing (dysphagia).

What tests diagnose pericardial problems?

Your provider may run one or more of the following tests to diagnose pericardial problems:

• Blood tests to check for infections, immune system conditions and markers of inflammation.
• Chest X-Ray.
• Cardiac computed tomography (CT) scan.
• Echocardiogram (echo).
• Electrocardiogram (ECG/EKG).
• Left and right heart catheterization.

What are common treatments for pericardial conditions and disorders?

Treatment depends on your condition and its severity. Your provider will talk with you about your treatment options and the urgency of your situation. Some common options include:

• Antibiotics or antifungal medications: Treat underlying infections that cause pericardial diseases.
• Rheumatologic drugs: Treat underlying rheumatologic disorders such as lupus or rheumatoid arthritis that can cause pericardial diseases.
• Anti-inflammatory medications and immunologic drugs: Reduce inflammation and swelling.
• Diuretics: Removes excess fluid from your body.
• Needle aspiration (pericardiocentesis): Removes excess fluid from your pericardium.
• Pericardiectomy: Removes part or all of your pericardium.
• Video-assisted thoracic surgery (VATS): Removes excess fluid from your pericardium.

How can I care for my pericardium?

Following a heart-healthy lifestyle is one of the best things you can do. Conditions like heart attacks and heart failure can cause pericarditis and pericardial effusion. So, lowering your risk of those conditions can help you keep your pericardium healthy, too.

Tips for following a heart-healthy lifestyle include:

• Eat a heart-healthy diet.
• Exercise regularly, with your provider’s guidance.
• Manage conditions like high blood pressure, high cholesterol and diabetes.
• Take your medications as prescribed.
• Visit your provider for yearly check-ups and keep all your follow-up appointments.

Other medical conditions and diseases can cause pericardial problems. If you have any of these diagnoses, talk with your provider about how they might affect your heart:

• Cancer.
• Chronic immune diseases like lupus, rheumatoid arthritis and scleroderma.
• HIV.
• Hormonal disorders, like hypothyroidism and ovarian hyperstimulation syndrome.
• Kidney disease.
• Tuberculosis.

Certain medical procedures and treatments can also cause pericardial problems. Talk with your provider about your risk for pericardial issues after:

• Heart surgery.
• Radiation therapy.

In general, do as much as you can to be an active partner in your medical care. Talk with your provider about your risks for cardiovascular disease and how you can reduce them.