Foreign body in the myocardium as a cause of constrictive pericarditis

Abstract

An unusual case of constrictive pericarditis, caused by lodging of a needle in the heart wall, is presented and discussed. Attention is focused on the rapid development of the constriction and the benefit gained from surgical intervention.Constrictive pericarditis due to foreign bodies is exceedingly rare. During the past three decades the relationship between trauma and constrictive pericarditis has been established in welldocumented cases (Warburg, 1933;Glenn, 1940;Straus, 1944;Watts and Toone, 1945;Mortensen and Warburg, 1948;McKusick, 1952).The injurious agents are many, including needles (Straus, 1944) and knives (McKusick, 1952). The relationship between trauma and the development of constrictive pericarditis has been questioned by Robertson and Arnold (1962), and McKusick (1952) states that trauma should not be overlooked in the aetiology, although in his view this cause has never been proven unequivocally.It is the purpose of this paper to describe another case of this condition. Of special interest is the fact that constrictive pericarditis developed very rapidly in this patient, a point which raises the question of the need for prompt surgical intervention in similar cases. CASE REPORTA 32-year-old woman was admitted to the TelHashomer Hospital in August 1953 because of congestive heart failure. One month earlier, while under treatment in a mental hospital, the patient attempted suicide by inserting needles into her chest. Within less than a week she developed fever and transient arrhythmias. She had several episodes of peripheral shock.Physical examination in our hospital revealed an undernourished woman in no acute distress. Her body temperature was 38°C.. the blood pressure was 120/ 100 mm. Hg, and the heart was in sinus rhythm at a rate of 130 per minute. The cardiac impulse was hardly palpable. On percussion there was an increased area of cardiac dullness. The heart sounds were distant but clear. A pleuropericardial friction rub was heard over the lower end of the sternum. There was dullness at the base of the right lung with diminished breath sounds. Moist rales were heard over the left base. The liver was palpable three fingerbreadths below the costal margin and was tender. Paradoxical pulse, Broadbent's sign, and systolic retractions at the apex were absent.FIG. 1. Chest radiograph showing the presence of three needles, two of which are seen to be embedded between the chest wall and the heart, while the third is thought to be embedded within the myocardium. 238 on 9 May 2018 by guest. Protected by copyright.

Management of Metallic Foreign Bodies in the Heart

“…Such patients usually suffer from mental disorders and alcoholism. Self‐inflicted injury is usually an expression of depressive behaviors or a suicide attempt 5‐7,10,11 , 15‐18 …”

Chronic constrictive pericarditis caused by self-mutilation with sewing needles. A case report and review of published reports.

“…The first resembles our case: this was another mentally ill Chronic constrictive pericarditis caused by self-mutilation with sewing needles patient who inserted sewing needles slsto her chest. 6 In this instance, however, the constriction developed five months later and was clearly a sequel to acute pericarditis resulting from the insult. In the other case constrictive pericarditis followed the loss of an intracardiac needle during a cardiac arrest and took six years to develop.…”

An unusual traumatic cause of cardiac tamponade and mitral regurgitation

“…In an eXfensive review, Barrett (1949Barrett ( -1950 found that foreign bodies could migrate to the heart from almost any part of the body. Needles have passed along the veins to the heart (Shapiro, 1941), but in most cases needles have penetrated directly through the chest wall into the heart (Barrett, 1949(Barrett, -1950Cope, 1920;Goldberger and Clark, 1935;Holdefer et al, 1966;Kishon et al, 1967;Markowitz et al, 1976;Straus, 1944). Presentation as canliac tamponade is common and the occurrence of Beck's triad of hypotension, increased venous pressure, and diminished heart sounds is of value in diagnosis and prognosis (Wilson and Basett, 1966).…”

“…Presentation as canliac tamponade is common and the occurrence of Beck's triad of hypotension, increased venous pressure, and diminished heart sounds is of value in diagnosis and prognosis (Wilson and Basett, 1966). Self insertion is rare; Kishon et al (1967) report a patient in a mental hospital who attempted suicide by this means on two occasions, and subsequently presented with constrictive pericarditis. Our patient presented with cardiac tamponade on the first occasion.…”

“…However, other early attempts resulted in considerable mortality (Goldberger and Clark, 1935;Straus, 1944). Removal of needles is necessary in order to prevent embolization of the needles or of associated thrombus (Holdefer et al, 1966), to pre-vent or cure infective endocarditis (Markowitz et al, 1976), to prevent recurrent pericardial effusions or constrictive pericarditis (Barrett, 1949(Barrett, -1950Breaux et al, 1979;Kishon et al, 1967;Straus, 1944), to reduce the damage to the myocardium either directly (Goldberger and Clark, 1935) or by abscess or aneurysm formation, and in the treatment of pain.…”