Complex gunshot injury to the heart as a consequence of suicide attempt in a schizophrenic patient

Highlights • Self- inflicted gunshot injury to the heart is uncommon in Western Europe. • Up to 40% of schizophrenic patients have history of suicide attempt. • Young age, depression, alcohol or drug misuse, history of prior suicide attempt, and discontinuation of antipsychotic medications are the major risk factors for suicide among individuals with schizophrenia. • Midline sternotomy provides superior access to the heart and large vessels, pulmonary hilum as well as for access for extracorporeal circulation.