Layers of the Heart

The heart is encased in two protective layers. The outer layer, the pericardial sac, covers the heart. It folds in on itself at the aorta forming the epicardial surface of the heart. Between these layers is a small amount of fluid that provides a non-stick surface between these layers.

Pericarditis, an infection within the pericardial sac, can cause increased friction between the inner surfaces of these layers. Chest discomfort is common. A friction rub, a sound similar to that produced by rubbing leather together – may also result. Note also that an accumulation of relatively small amounts of fluid (200 ml) in this pericardial sac – pericardial effusions – can straight jacket the heart’s ability to contract. This condition called cardiac tamponade may result in little or no cardiac output.

The epicardium forms the outer layer of the heart. The myocardium forms the middle layer and the endocardium the innermost layer of the heart.

Chambers and Layers of the Heart

The coronary arteries provide blood to the heart tissues, carrying blood first across the epicardium, then the myocardium and finally terminating in the endocardium.

The endocardium claims the dubious position as the terminus for the coronary arteries. Since the coronary arteries begin along the epicardial surface, enter the myocardium and terminate in the endocardium, myocardial ischemia rarely occurs without endocardial ischemia. While the endocardium is damaged in most every myocardial infarction, the epicardium’s location in the blood flow hierarchy increases its safety factor.

The endocardium releases hormones such as:

endocardin, a substance that prolongs myocardial contraction;

atrial natriuretic factor (ANF), released by the atria to oppose the activity of epinephrine, endothelin and the renin-angiotensin system

brain natriuretic peptide (BNP) which is released by the ventricles upon ventricular distention having similar effects to ANF.

The heart is not just a pump but also an endocrine organ!

1. Six Second ECG Guidebook (2012), T Barill, p. 10

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