| Therapeutic intervention

Median sternotomy was then carried out under general anesthesia and endotracheal intubation. A large hematoma was found on the pericardium upon opening. The pericardium was incised, and the clot along with a considerable volume of blood was drained. The syringe needle (Figure 4,5) was discovered within the right ventricle. The entry point of the needle was identified as originating from the left pleural cavity into the pericardial cavity; subsequently, the needle was extracted (Figure 6) manually, without employing a cardiopulmonary bypass machine, from the heart, and the bleeding site was secured utilizing a suture. Following the placement of a drain in both the left pleural and pericardial spaces, the chest was closed and transported to the Intensive Care Unit (ICU) in stable condition. The patient was released after six days under psychiatric care and medication, including haloperidol, lorazepam, amitriptyline, imipramine, and antibiotics.