Anatomy Fibrous pericardium the tough outermost membrane that anchors the heart within the mediastinum.

m. Serous pericardium inner membrane consists of visceral and parietal pericardium. Visceral pericardium clings to the heart. AKA epicardial layer of the heart. Parietal pericardial lies between the visceral layer and fibrous pericardium. The pericardial fluid reduces friction within the pericardium by lubricating the epicardial surface allowing the membranes to glide over each other with each heart beat.

Pathophysiology As pericardial pressure increases, filling of each cardiac chamber is sequentially impaired. The lowerpressure cardiac chambers (atria) are affected before higher-pressure chambers (ventricles); it means systole for the atria, diastole for the ventricles. Filling pressure becomes elevated as a compensatory mechanism to maintain cardiac output. Such elevated intracardiac filling pressure, produces a decrease of ventricular filling and stroke volume. Because compromised chambers cannot accommodate normal venous return, system and pulmonary venous pressures rises. Risks a toxic condition resulting from kidney disease due to retention in the bloodstream of waste products normally excreted in the urine ECG Alternation of QRS complexes on electrocardiographic findings is called electrical alternans. It is caused by movement of the heart in the pericardial space. Doppler A very large hemorrhagic pericardial effusion due to malignancy as seen on ultrasound which was causing tamponade. closed arrow: the heart, open arrow: the effusion XRAY shows a massive, bottle-shaped heart.