Injuries of the heart and great vessels due to pins and needles.

Three instances of cardiac injury from needles in two adults are described. Trauma was accidental in one and due to suicidal attempts in the other two. The objects were removed. There are 157 published accounts of wounding of the heart and/or great vessels by pins and needles. The victims have ranged from infants to the elderly. Causative agencies were accidents, suicide, and homicide. A few were discovered at necropsy in presumably asymptomatic persons. Six of the accidental injuries were iatrogenic. The objects reached the heart or great vessels from transthoracic insertion, ingestion, embolization, aspiration, or transabdominal penetration. The overall mortality incidence was about 50%. Acute cardiac tamponade was the dominant cause of death. Almost all individuals survived who were operated upon and from whom the object was removed. The right ventricle was hurt most often, but no region of the heart or of the great vessels was spared. Occasionally multiple parts were affected. The primary damage occurred principally while the foreign body was extracardiac and relatively immobilized, from repetitive scratching or puncturing of the beating heart. Chest pain and unfolding patterns of tamponade were inconsistent in onset, severity, and duration. Death ensuing days or weeks after the initial injury was frequent. Progressive haemopericardium in some cases was due to or aggravated by laceration of a structure from within outward. Late complications—several fatal—were consequent upon inflammation, sepsis or thromboembolism. It is urged that all foreign bodies in the heart or great vessels be retrieved, even if seemingly innocuous clinically.