Endocarditis due to accidental penetrating foreign bodies

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).…”

“…Acute pericarditis leading to an effusion and tamponade would account for the initial presentation and the needle could have acted as a nidus of infection. Infective endocarditis has been reported secondary to accidental penetration of the heart by a nail (Markowitz et al, 1976). Damage to the mitral valve or its chordae has not previously been reported and most injuries to the mitral valve are found at post mortem (Symbas, 1978).…”

“…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.…”