How dangerous is removing a weapon from a heart wound? [closed]

Question

When Steve Irwin was killed by a stingray in 2004, reports said that the stingray barb broke off, lodged in his heart, and that he pulled it out which caused him to bleed to death.

Ten years later the cameraman with him said that the stingray stabbed what seemed like hundreds of times and that Irwin didn't try to pull out the barb. Thus it seems that the barb didn't break off and stay lodged in Irwin's heart.

Obviously it is not always medically necessary to remove a weapon like a bullet, knife, or arrowhead from a victim's body, since many persons have survived for years and decades with bullets and arrowheads in parts of their bodies.

And I have read that in some cases it is better to leave a bullet, knife, or arrowhead in the body than try to remove it, since feeling around inside the wound with unwashed fingers can cause infection, pulling it out can cause more damage to tissues, and the weapon might be plugging up arteries it has severed.

Thus many times thought should be given to how and if to remove a weapon from a victim's body.

And I have read that some people have survived wounds to the heart, and thus not all heart wounds need to be fatal, some can be survived under the right circumstances.

So is it medically possible for someone to be wounded in the heart, with the weapon plugging the wound it makes, so that the weapon shouldn't be pulled out until and unless doctors are prepared to immediately close the heart wound and stop the bleeding?

Could it be a fatal mistake to pull a weapon out of one's heart, as was alleged in some stories about Steve Irwin's death?

Answer 1

I'm going to focus on stingray stings to the heart, which are rare, (but not rare enough that there's nothing to cite, I guess).

Yanking out a stingray sting will cause lacerations (assuming it doesn't just break, leaving part still embedded in the body), which is not something you want to do if the sting is lodged near a part of your body that can bleed a lot:

The sharp, arrow-like tip and backward pointing teeth of the stingray spine make the structure an effective weapon. The spine is so constructed that penetration of the victim's flesh is accomplished with ease, but the removal of the barb is difficult and lacerates the tissues as it is withdrawn. The sheath of the sting is easily damaged. When the sting penetrates the flesh the sheath is torn, the dentate margins of the sting are exposed and, venom released. Laceration of the tissues aids in the absorption and distribution of the toxin, thus producing a violent tissue reaction.
_{Stingray Attacks and their Treatment (paywall)}

However, unlike bullets, the stings are venomous and can cause necrosis, so it's not a good idea to leave them in the body, which is why surgery is performed to remove any remaining stinger.

According to this paper, as of 2013 there are only three known cases where people survived being stung in the heart by a stingray. (The paper itself describes a different situation, where someone was stabbed by another person and lived with a stinger in "nonvital areas of the heart" for 17 years until it was surgically removed. The important difference is that the stinger had no venom.)

The three cases are:

1. Cardiac wound caused by the spine of the stingray (summarized here):

   • No evidence of necrosis from the venom in this case. As there was incomplete penetration of the ventricular wall, there was no substantial blood leakage and no cardiac tamponade, making this dramatic injury survivable.

2. Survivor of a stingray injury to the heart:

   • Our patient was fortunate to have sustained an injury to a coronary artery rather than to the myocardium. The artery, by bleeding, immediately washed the venom away, whereas injury to the myocardium is difficult to debride and carries a risk of delayed necrosis and perforation.

3. Surviving a transfixing cardiac injury caused by a stingray barb:

   • To our knowledge, the case presented is the first and only reported survivor of a transfixing cardiac injury caused by a stingray barb. Our success was largely due to an integrated trauma system, with rapid transport by our prehospital providers, initial stabilization by the surgical staff at the receiving facility, and expeditious referral to the regional trauma center for definitive care.

In all three of these cases, there was some barb left in the heart which was removed via surgery. In addition, the lack of necrosis seems to have been key to survival, since the second paper cites another paper where a boy died from necrosis reaching his heart days later (it doesn't look like he needed surgery to remove the stinger in the first place, but I'm not sure if it actually stabbed his heart or not).