Acupuncture-Related Cardiac Complications: A Systematic Review
Waqas Ullah, Asrar Ahmad, Maryam Mukhtar
1St. Mary Medical Center, 1203 Langhorne-Newtown Road, Suite 320, Langhorne, PA 19047 USA. Vincent.figueredo@stmaryhealthcare.org.
Insights
Acupuncture can lead to serious cardiac complications like cardiac tamponade (CT) and infective endocarditis (IE). While rare, these events, particularly CT, carry a high mortality risk, necessitating safer acupuncture practices.
Area of Science:
- Cardiology
- Integrative Medicine
- Medical Complications
Background:
- Acupuncture, a traditional therapy, is generally considered low-risk.
- However, rare but severe cardiac adverse events have been reported.
- Literature lacks a comprehensive review of these acupuncture-related cardiac complications.
Purpose of the Study:
- To review and consolidate reported cases of cardiac complications following acupuncture.
- To determine the incidence and characteristics of these adverse events.
- To highlight the potential risks associated with acupuncture procedures.
Main Methods:
- A systematic search of computerized databases using Medical Subject Headings (MeSH) was conducted.
- References from relevant articles were also manually reviewed.
- Data from retrieved articles on cardiac adverse events were analyzed.
Main Results:
- Out of 133 retrieved articles, 30 cases of cardiac adverse events were identified.
- These included 8 cases of infective complications (primarily infective endocarditis) and 22 cases of cardiac tamponade.
- Cardiac tamponade had a higher weighted mortality rate (80%) compared to infective complications (20%).
Conclusions:
- Despite acupuncture's generally low complication rate, reported cardiac events are alarming.
- Cardiac tamponade is a significant risk, especially when acupuncture needles are inserted near the heart.
- Increased education on safer acupuncture techniques is crucial to prevent severe outcomes.
Background:
The objective of this study is to review acupuncture-related cardiac complications, such as infective endocarditis (IE), cardiac tamponade (CT), pericarditis, and cardiac rupture, as there is no known reported literature to determine the burden of cardiac adverse events due to acupuncture.
Methods:
Structured computerized databases were searched using the special Medical Subject Heading (MeSH). Manual search using the references of relevant articles was also performed.
Results:
A total of 133 articles were initially retrieved, but careful reading resulted in only 30 cases of relevant cardiac adverse events. There were 8 articles of infective complications (mostly IE), while 22 articles of CT have been reported to date. The diagnoses were made with echocardiography and patients were treated with intravenous antibiotics. The source of the infection was mostly localized to acupuncture needle prick sites, such as earlobes and legs. Mortality rate for post-acupuncture CT was not significantly higher than infective cardiac complication (Pearson's Chi-square = 0.559; likelihood ratio = 0.553). However, the weighted percentage of death was about 80% in CT vs only 20% mortality for infective cardiac complications. On the other hand, CT was the most common presentation when the needle pricks were close to the heart, and had a clinical presentation of hypotension and venous distention.
Conclusions:
Although the universally reported complications of acupuncture are low, and the procedure itself has been deemed low risk in acupuncture-related literature, these cardiac complications are alarming. To avoid these potentially catastrophic consequences, more education needs to be done for adopting safer techniques.
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