# Management of a recurrent suicide attempt with needle insertion into the heart; a case report

## TL;DR

A 29-year-old man with bipolar disorder survived a second suicide attempt involving self-inserted needles into his heart, successfully treated with surgery and psychiatric care.

## Contribution

This case report highlights the rare and dangerous practice of self-inflicted cardiac needle insertion and its successful multidisciplinary management.

## Key findings

- Needle insertion into the heart is extremely rare and poses significant medical risks.
- Prompt imaging and surgical intervention are critical for survival in such cases.
- A multidisciplinary approach combining medical and psychiatric care is essential to prevent recurrence.

## Abstract

Penetrating cardiac injury (PCI) is rare and life-threatening, with complications that include hemorrhage, tamponade, arrhythmia, and cardiac arrest. Needle insertion into the heart is infrequently reported; to our knowledge, only one case of recurrent self-insertion has been described.

A 29-year-old man with bipolar I disorder and a prior sternotomy for foreign-body removal presented after a second suicide attempt within two years, having self-inserted multiple needles through the chest and abdomen. Chest radiography showed three metallic densities in the left hemithorax and one in the abdominal wall. Transthoracic echocardiography demonstrated a linear metallic echo within the left ventricle (LV) near the apex. Computed tomography confirmed three metallic densities in the left thorax, one penetrating the LV to a depth of 30 mm. Median sternotomy was performed, and one needle was removed from the LV. After recovery, the patient was transferred to a psychiatric hospital for further inpatient treatment.

Intentional cardiac injury by needle insertion is extremely rare and poses diagnostic and therapeutic challenges. Early imaging and prompt surgery are essential to reduce morbidity and mortality. A multidisciplinary plan, including psychiatric evaluation and follow-up, is required to prevent fatal outcomes and recurrence.

This study describes the successful management of a penetrating cardiac injury in a patient with a prior sternotomy.

•Penetrating cardiac trauma remains a rare but life-threatening injury.•Self-insertion of needles into the heart is a medical and psychiatric emergency.•Prompt diagnosis and intervention are needed to manage cardiac complications.•A multi-disciplinary approach is needed to prevent recurrence.

Penetrating cardiac trauma remains a rare but life-threatening injury.

Self-insertion of needles into the heart is a medical and psychiatric emergency.

Prompt diagnosis and intervention are needed to manage cardiac complications.

A multi-disciplinary approach is needed to prevent recurrence.