1114 NSTEMI originated from an insulin injection needle
Abstract A fifty-eight-old previously healthy woman presented to the emergency department with chest pain radiating to the retrosternal area on her way to work. Initial ECG showed no ST-T segment change, but the troponin level was elevated. Urgent coronary angiography demonstrated normal coronary arteries. Ergonovine provocation was also undergone, and no coronary spasm was provoked. During angiography, a fine mobile artifact near the distal portion of left anterior descending artery was observed (Figure A and B, yellow arrow). Her chest wall was fully clear without recent injury. She didn"t receive any acupuncture treatment or is not an intravenous drug user. She is a factory worker making insulin injection needle. Echocardiography showed a hyperechogenic sharp foreign body penetrating interventricular septum with color jet (Figure C and D, yellow arrow). No pericardial effusion was observed. She underwent surgery to remove the foreign object. A fresh fine needle approximately 23 mm-long was entirely removed without extensive dissection under fluoroscopic guidance (Figure E and F). Her symptom was fully resolved after removing the needle and she discharged without further event. Abstract 1114 Figure.
