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The heart is enclosed within a delicated fibrous sac known as the pericardium.

The outer wall fibrous or parietal pericardium The inner wall visceral pericardium or epicardium

The two pericardial wall is seperated by a space lined with a mesothelium. The attachments of the pericardium: Anteriorely- posterior surface of the sternum posteriorly & superiorly great vessels & loose connective tissues within the post. Mediastinum Inferiorly fused with cental tendon of the diaphragm


is the condition in which the pericardium becomes thickened, fibrosed & calcified. The pericardial cavity is obliterated by dense scar tissue. The heart is infact is confined in a rigid inelastic case preventing it from its proper functioning.

The pathological effect of this condition is that it prevents ventricles from filling in diastole. This causes decreased cardiac output. A compensatory tachycardia is seen. There is corresponding increase in right atrial pressure and right ventricular pressure. There is also elevation of cental venous pressure. This hypertension may produce periferal oedema, hepatic enlergement and ascites.




benign pericarditis Following hemopericardium Connective tissue diseases Radiation therapy to chest Uremic Idiopathic RA


Due to impaired filling of RIGHT side of heart

Due to impaired filling of LEFT side of heart


A. Due to impaired filling of RIGHT side of heart 1. Raised venous pressure Kussmauls sign Friedreichs sign

2. Cardiac signs

Palpation: Systolic retardation of the apex beat diastolic shock Auscultation: Loud early 3rd sound


to impaired filling of left heart

1. syncope on exertion 2. dyspnoea

1. Chest radiograph Calcification of pericardium Dilated superior vena cava

2. ECG T terminal negativity May be atrial fibrillation 3. Echocardiography Small ventricles & enlarged atria The pericardium single or double dense Immobile heart Inferior vena cava & hepatic veins largely dilated 4. MRI Thickened pericardium

1. 2. 3. 4. 5.

Restrictive cardiomyopathy Cirrhosis of liver Congestive cardiomyopathy Tricuspid valve disease RV infarction


Realive the constriction


The heart is approched through a median sternotomy and pericardium is carefully stripped off the left ventricle, followed by the right ventricle. Sometimes cardiopulmonary bypass may be required .

Day 0. No treatment Day 1. Arm & leg exercises in half lying, Breathing exercises Day 2. First walk Day 3. Increased walking Day 4. Walking about 100 yards with no shortness of breath, begin stair climbing Day 5. trunk exercises, increase stair climbing & walking Day 7. breathing exercises, neck, trunk, shoulder girdleexercises, teaching home exercises

Pt. Will advised that he should not drive for 6 weeks & sexualrelations should be avoided for 4 weeks after leaving hospital.