A young man with a heavy heart

Abstract

A 34 year old man presented with acute chest pain. His ECG was very abnormal but stable and he was treated with opiate analgesia. When his condition did not improve, chest radiography and cardiac ultrasound were performed. Both revealed metal dense deposits in the heart. On questioning, the patient revealed that he had self injected with mercury 15 years before. Self injection of elemental mercury is rare but well described and normally used by those who are suicidally depressed or who seek to improve sexual or athletic performance. Intravenous mercury may be deposited in the right heart and can result in ECG abnormalities, which may later be mistaken for changes due to coronary or other cardiac disease and result in inappropriate medication and hospitalisation.

Figure 1

12 lead ECG at presentation showing widespread anterior and inferior T wave changes.

Figure 2

Chest x ray showing metal dense deposits within the cardiac silhouette at the apex of the right ventricle, and multiple small metal dense deposits scattered throughout both lung fields.