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The pericardium is a 2-layered sac that contains the heart and the proximal parts of the great vessels. The outer surface of the sac is termed the parietal pericardium and is lined by mesothelial cells. The inferior part of the sac is attached to the diaphragm. The inner layer of the sac, also lined by mesothelial cells, is attached to the cardiac surface and is known as the visceral pericardium. A small amount of fluid fills the cavity between the pericardial layers and acts as a lubricant so that the heart can move within the sac. The parietal pericardium has blood and lymphatic vessels. Disorders that affect the pericardium may be primary or secondary to disease elsewhere in the body, including the heart itself.

Whatever the cause, there are only 3 manifestations: acute or chronic inflammation of the pericardial sac in response to injury or accumulation of fluid between the 2 layers—a pericardial effusion with or without a tamponade.

Acute pericarditis has many causes (see Table 491-1). No matter what the cause, the presentation is similar.

Table 491-1 Etiologya of Pericarditis

  1. 1. Chest pain is usually precordial and often referred to the neck, shoulder, or epigastrium. The pain is sharp or burning and is usually made better by sitting up and leaning forward. It is made worse by taking in a deep breath because inspiration lowers the diaphragm, pulls the pericardial sac down, and narrows it, thereby causing ...

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