Needle embolisms in the heart are quite rare, and their management is largely based on clinical experience. We describe a patient with chest pain and shortness of breath, whose electrocardiogram revealed subtle inferolateral ST segment elevations. The patient was found to have a bloody pericardial effusion causing tamponade from a long-ago injected needle. Removal of a needle is a complicated decision, that should be done in a multi-disciplinary fashion to minimize complications. Removal may not always be necessary if the needle is in a stable position and not in danger of migration.

Needle embolisms in the heart are quite rare and their management is largely based on clinical experience. We describe a patient with chest pain, shortness of breath and EKG demonstrating subtle inferolateral ST elevations found to have a bloody pericardial effusion causing tamponade from a long-ago injected needle.