Life-threatening cardiac tamponade: a rare complication of acupuncture

Acupuncture is an ancient form of Chinese medicine involving the insertion of solid filiform acupuncture needles into the skin at specific points on the body to achieve a therapeutic effect. It has become popular in the rest of the world as well as East Asia in recent decades. It is regarded as a safe treatment method for many conditions, if it is performed according to established safety rules at appropriate anatomical regions. A number of large surveys on the safety of acupuncture have been conducted, mainly in Europe. However, serious lethal complications including death have been reported although it is generally believed to be a safe.

We present a rare case of life-threatening cardiac tamponade due to penetration of an acupuncture needle directly into the right ventricle.

This case highlights that acupuncture, which entails inserting and manipulating fine needles into specific bodily points with the aim of relieving pain and for therapeutic purposes, can cause a catastrophic conditions, including life-threatening cardiac tamponade caused by direct penetration of an acupuncture needle into the right ventricle. Although acupuncture is a very safe procedure in the hands of a competent practitioner, several serious complications have been described in the scientific literature[1]. Thus far, seven cases of cardiac tamponade associated with acupuncture have been reported[1–4]. It is said that direct perforation of myocardium or migrated acupuncture needles from a remote site can cause cardiac tamponade. Because the distance from the surface of the skin to the anterior surface of heart was estimated to be only about 13–19 mm, even an experienced acupuncturist might penetrate the cardiac chamber or the coronary arteries with acupuncture needles (which are 30 mm in length). In this case, the acupuncture needle may have been inserted in a perpendicular direction through a chest wall likely rendered thinner by a mastectomy. Two similar case reports have been published documenting fatal cardiac tamponade caused by direct mechanical injury to the right ventricle in an elderly patient with emaciation and by acupuncture through a congenital sternal foramen[2, 4]. A sternal foramen was not found during sternotomy in our patient. Echocardiography is a valuable tool for the evaluation of shock, cardiac tamponade and hemodynamic instability of unknown origin. With the help of echocardiography, we swiftly made an emergent decision that lead to successful management of this case.

The diagnosis of cardiac tamponade induced by an acupuncture needle should be considered when unexplained shock after an acupuncture procedure at the chest wall is found.

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.