The pericardium consists of a serous or loose fibrous membrane (visceral pericardium) overlying the epicardium and a dense collagenous sac (parietal pericardium) surrounding the heart. The space between the visceral and parietal pericardium may contain up to 50 mL of fluid under normal conditions, and intrapericardial pressure is normally subatmospheric. Because its layers are serosal surfaces and because of its proximity and attachments to other structures, the pericardium may be involved in a number of systemic or localized disease processes (Iable..51-6). The clinical presentation of pericardial heart disease is variable and dependent on the pericardium's response to injury and how this response affects cardiac function. In this section the clinical manifestations and evaluation of acute and constrictive pericarditis and nontraumatic cardiac tamponade are discussed.18
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