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Chapter 66: Pericardial Diseases

Which of the following is correct regarding the normal anatomy and physiology of the pericardium?

A. It allows great distention of the cardiac chambers and increased cardiac filling

B. Congenital absence or surgical removal of the pericardium is fatal

C. The human pericardium consists of two distinct layers, the inner serosa and the outer fibrosa

D. Most of the innervation of the pericardium occurs via the vagus nerves

E. All of the above

The answer is C. (Hurst’s The Heart, 14th Edition, Chap. 66) The human pericardium has two distinct layers; the serosa is composed of a single column of mesothelial cells that surrounds all four cardiac chambers and the proximal great vessels and reflects on itself to form the inner surface of the fibrosa, a fibrocollagenous structure (option C). This monolayer of serosal cells covering the surface of the heart and epicardial fat is also called the visceral pericardium, whereas the fibrosa and the reflection of the serosa make the parietal pericardium.

Most of the innervation of the pericardium occurs via the phrenic nerves (C4–C6), which course anteriorly (option D); this is particularly relevant during pericardiectomy. No adverse consequences follow congenital absence or surgical removal of the pericardium (option B). However, the pericardium serves many important (although subtle) functions. It limits distension of the cardiac chambers and facilitates the interaction and coupling of the ventricles and atria (option A). Limitation of cardiac filling volumes by the pericardium may also limit cardiac output and oxygen delivery during exercise.

A 49-year-old man presents to clinic with pleuritic chest pain, myalgia, and fever. Which of the following findings is not a diagnostic criterion for acute pericarditis?

A. New widespread ST elevation or PR depression on ECG

B. Sharp chest pain that is worse on inspiration

C. Fever > 38°C

D. Pericardial friction rub

E. New or worsening pericardial effusion

The answer is C. (Hurst’s The Heart, 14th Edition, Chap. 66) The clinical diagnosis of acute pericarditis is established when two of four clinical criteria are satisfied (Table 66-1). Acute pericarditis is usually characterized by sharp retrosternal pain (option B) that is aggravated by lying down and relieved by sitting up; its onset is often heralded by a prodrome of fever, malaise, and myalgia. The most specific physical sign can be the presence of a pericardial friction rub (option D), which is identifiable in no more than ...

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