pericardial

Pericardial is an adjective referring to the pericardium, the double-walled sac that encloses the heart and the roots of the great vessels.

Anatomy and structure: The pericardium comprises a tough fibrous layer and a serous layer. The serous pericardium is divided into a parietal layer that lines the fibrous sac and a visceral layer that adheres to the myocardium, also known as the epicardium. The space between the parietal and visceral layers is the pericardial cavity, which normally contains a small amount of lubricating fluid to reduce friction during cardiac movement.

Function: The pericardium anchors the heart within the mediastinum, provides mechanical protection, limits excessive dilation during volume changes, and reduces friction between the heart and surrounding structures.

Clinical relevance: Pericardial disease includes pericarditis (inflammation of the pericardium), pericardial effusion (accumulation of fluid in the pericardial space), and cardiac tamponade (compression of the heart due to rapid fluid accumulation). Constrictive pericarditis results from a thickened or scarred pericardium that impairs cardiac filling. Etiologies vary and can include infections (often viral), autoimmune or inflammatory diseases, malignancy, uremia, post-surgical or post-infarction processes.

Diagnosis and treatment: Echocardiography is the primary diagnostic modality for pericardial conditions, with electrocardiography potentially showing characteristic changes in pericarditis. Management depends on the underlying disorder: anti-inflammatory therapies (such as NSAIDs or colchicine) for uncomplicated pericarditis; pericardiocentesis to drain significant effusions or tamponade; and pericardiectomy for constrictive pericarditis or recurrent cases.