title: Cardioembolic strokes resulting from a self-inflicted needle puncture involving both sides of the heart.
abstract: Foreign bodies in the heart are rare occurrences with a limited evidence base to guide recommendations on management. We report a case of multiple cardioembolic strokes as a result of a self-inflicted sewing needle puncture from the anterior chest through the right ventricle and interventricular septum with its tip in the left ventricle close to the subvalvular apparatus in a 39-year-old psychiatric patient. We discuss issues surrounding decision making and ongoing care and highlight the importance of further follow-up and reporting of cases to form a robust evidence base to guide future recommendations.
authors.affiliation: Department of Anaesthesia, Salford Royal NHS Foundation Trust, Salford, United Kingdom.
authors.forename: Mark Zheng Yi
authors.identifier: http://orcid.org/0000-0003-3330-728X
authors.initials: MZ
authors.lastname: Tan
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital of South Manchester NHS Foundation Trust, Manchester, United Kingdom.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Brunswicker
authors.affiliation: Critical Care Unit, Manchester Royal Infirmary, Central Manchester NHS Foundation Trusts, Manchester, United Kingdom.
authors.forename: Shamsaldeen
authors.initials: S
authors.lastname: Abdelraheem
authors.affiliation: Critical Care Unit, Manchester Royal Infirmary, Central Manchester NHS Foundation Trusts, Manchester, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Sheehan
mesh_terms: D000328:Adult; D004452:Echocardiography; D004618:Embolism, Air / Q000150:complications* / Q000000981:diagnostic imaging; D017809:Fatal Outcome; D005260:Female; D005547:Foreign Bodies / Q000150:complications*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000293:injuries*; D006801:Humans; D001523:Mental Disorders / Q000150:complications*; D009339:Needles; D011677:Punctures; D016728:Self-Injurious Behavior / Q000150:complications*; D020521:Stroke; D014057:Tomography, X-Ray Computed; D054088:Ventricular Septum / Q000000981:diagnostic imaging / Q000293:injuries*
keywords: cardioembolic; foreign body; psychiatry; self-harm; stroke; transthoracic