Khanipour Ramtin, Mazmanian Saro, Jung Andrew, Dahhan Ali
Division of Cardiology, HCA Healthcare-HCA Florida Bayonet Point/USF Morsani College of Medicine, 14000 Fivay Rd, Hudson, FL 34667, USA.
Eur Heart J Case Rep. 2025 Aug 31;9(9):ytaf380. doi: 10.1093/ehjcr/ytaf380. eCollection 2025 Sep.
Traumatic penetrating cardiac injuries are usually immediately fatal. The management approach (surgical vs. conservative) in surviving patients can be challenging. A conservative approach is appropriate in selective cases; however, long-term complications should be considered.
A frail 83-year-old male who had undergone coronary artery bypass grafting surgery 20 years ago presented with encephalopathy. He had persistent bacteraemia. Chest computed tomography revealed three metal nails penetrating the anterior thoracic wall through the myocardium. Later, we learned that he had attempted suicide 2 years ago by shooting himself in the chest using a nail gun. Conservative non-surgical approach was pursued at that time given his multiple comorbidities. We adopted a conservative approach again. He survived for additional 6 months on chronic suppressive antimicrobial therapy but ultimately passed away from pneumonia.
The favourable outcome in this patient underscores the role of a conservative approach in selective cases. Retained foreign bodies pose a risk of infective endocarditis; therefore, empirical chronic antimicrobial therapy and tetanus vaccination should be considered.
创伤性心脏穿透伤通常会立即致命。对于存活患者，治疗方法（手术治疗还是保守治疗）颇具挑战性。在某些特定情况下，保守治疗方法是合适的；然而，应考虑长期并发症。
一名83岁体弱男性，20年前接受过冠状动脉搭桥手术，现出现脑病。他持续存在菌血症。胸部计算机断层扫描显示三根金属钉穿过心肌穿透前胸壁。后来我们得知，他在2年前曾用射钉枪朝自己胸部开枪试图自杀。鉴于他有多种合并症，当时采取了保守的非手术治疗方法。我们再次采用了保守治疗方法。他在接受慢性抑制性抗菌治疗后又存活了6个月，但最终因肺炎去世。
该患者的良好预后凸显了保守治疗方法在特定病例中的作用。体内留存异物存在感染性心内膜炎的风险；因此，应考虑经验性慢性抗菌治疗和破伤风疫苗接种。
