This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rossi, M. A. Articles by Agrizzi, R. S. Search for Related Content PubMed PubMed Citation Articles by Rossi, M. A. Articles by Agrizzi, R. S. Related Collections Cardiovascular imaging agents/Techniques Other etiology Acute myocardial infarction

(Circulation. 1999;99:843-844.)
© 1999 American Heart Association, Inc.

Images in Cardiovascular Medicine

Sewing Needle Transfixing the Posterior Wall of the Left Ventricle Causes Death

Marcos A. Rossi, MD, PhD; Daniel G. Alvarenga, MD; Rovana S. Agrizzi, MD

From the Departments of Pathology and Internal Medicine, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.

Correspondence to Professor Marcos A. Rossi, Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, 14049–900 Ribeirão Preto, SP, Brazil. E-mail marossi@fmrp.usp.br

Self-mutilation with a sewing needle and a fatal outcome due to a penetrating wound of the heart is exceedingly rare. To the best of our knowledge, the present image represents the best-illustrated case of such an occurrence.

A 64-year-old woman, a dressmaker, was admitted to the University Hospital because of intense dyspnea. On physical examination, the patient was pale, cyanotic, afebrile, and sweating profusely. The blood pressure was not obtainable. An ECG revealed ST-segment elevation >2 mV in inferior leads and >1 mV in lateral leads. A QRS pattern suggestive of myocardial necrosis was seen in lead V₁. The chest film showed an indistinct aortic contour, opacification of the space between the aorta and pulmonary artery, mediastinal widening, and interstitial pulmonary edema. Under the assumption that she had diaphragmatic myocardial infarction, she was medicated accordingly. After transfusion of packed red cells, the blood pressure rose (60 mm Hg systolic, 50 mm Hg diastolic), and the patient presented little clinical improvement. Thereafter, her responsiveness gradually declined, terminating in cardiac arrest and death 15 hours after entry. Five days earlier, the patient had been admitted to a Basic Health Unit complaining of epigastric pain radiating to the precordium. The physical examination revealed pallor and hypotension. Transfusion of fresh whole blood was given, and she was discharged in an improved condition. The patient had a past history of depression.

At autopsy, a sewing needle was found transfixing the posterior wall of the left cardiac ventricle (Figure). The tip of the needle . . . [Full Text of this Article]