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Ask an expert - body - chest - heart

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We are not quite sure from your question whether you mean atrial flutter or atrial fibrillation. The difference between them is not substantial - in fibrillation the increased atrial beat is irregular whereas in flutter the increase tends to be regular - but the impact of both is much the same: faintness, tiredness, palpitations, shortness of breath and dizziness.

We have answered questions on atrial fibrillation before, a typical answer being:

There are some early indications that acupuncture may have an anti-arrhythmic effect in patients with atrial fibrillation. A study published earlier this year

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312232/

concluded that there appeared to be benefits and that further large scale trials would be valuable to test the hypothesis more carefully.

However, it is only fair to say that needling a single point such as Neiguan repeatedly is not a fair representation of what a traditional acupuncturist does in practice. Although there is considerable overlap between eastern and western systems the arrhythmia typical of AF could be classified in several different ways within Chinese medicine, and the practitioner would be guided by evidence other than simply a reading of the rate of the pulse. That in turn would mean that ten people with AF might receive ten different treatments. To that extent, it is not that straightforward to extrapolate from research studies like this and conclude that 'acupuncture works'. 

The skill of the practitioner lies in making sense of the symptom of AF within an entirely different theoretical framework, and understanding each presentation in each individual patient as unique. The best advice we can give any prosepctive patient is to contact a BAcC member local to them to seek a short face to face consultation at which they can be given a better assessment of whether acupuncture might benefit them.

The one caution with AF is that most patients are taking some form of medication to control the problem, and the cessation of medication can quickly provoke a return of the symptoms. For people involved in highly technical or responsible work this might represent a serious risk. We would always recommend that any member contemplating treating someone with a condition like AF should talk to the patient's GP to ensure that nothing they do will undermine the current treatment regime. 

We have undertaken some further searches of the literature and these two articles

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321072/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673375/

say much the same as the earlier articles and indeed cite them frequently.

Most of us have treated AF cases, and they do represent something of a challenge because of the management of the case alongside western treatment and medication. Even where we manage to bring the episodes under control to a greater degree than the medication most medical practitioners are reluctant to stop the meds in case the patient has a serious recurrence when they are doing something which could have dangerous consequences (driving a car, etc etc). However, good dialogue can address these kinds of problems, and a patient with their symptoms under control is likely to be happy to facilitate good communication anyway.

The other slight issue is with the setting of outcome measures. AF can come and go, and a problem-free period can happen anyway, so a practitioner has to be careful to discuss with the patient what would count as evidence from the patient's perspective that there had been some progress.

This represents probably the best that we can still say. There is no evidence of research into atrial flutter as such, and we suspect that for the purposes of the trials which have taken place the distinction has not been drawn.

What we did not say in our earlier reply is that most of our members are only too happy to give up a little time to prospective patients, usually without charge, to give them a better idea of what may be possible. Most conditions like this do not occur in isolation from a Chinese medicine perspective, and there are often other signs and symptoms which together make more sense of what is happening. From a Chinese medicine perspective each person is unique and different, and although a dozen patients share the same named condition there may be a dozen different ways of looking at it and treating it. Having a  word with a skilled and experienced practitioner might make more sense of what is going on and give a better idea of how treatable it may be.

We suppose the underlying issue here is whether the mitral valve prolapse is actually connected to the symptoms which your son is experiencing. The ones which you report are not the standard problems noted in these cases, and if this is a separate and unrelated problem then it substantially changes the advice we can offer.

As far as the treatment of MVP itself is concerned there is no evidence that we can find that acupuncture treatment has been documented in helping to reduce the symptoms associated with MVP. There are several complementary medicine articles which point to the use of magnesium, which has been linked to the muscle weakness, but nothing which mentions treatment by acupuncture. Whether magnesium is effective as a supplement is beyond our scope for comment.

If, however, the symptoms are of a different problem related to a weakened immune system, i.e. not directly resulting from the MVP, then there may be some reason for cautious optimism. There have been a number of studies which have shown effective increases in immune response and immune system body chemistry as a consequence of treatment, and a greater number of studies of of successful treatment of some of the emotional disorders associated with a weakened immune response, anxiety being one of the primary ones. The research is far from conclusive, but suggestive of the fact that there may be a chance that change will happen.

The bottom line with complex presentations is that it really needs someone to take a look at the individual to see how the symptoms present against the backdrop of all aspects of the person's health. Not only does the traditional acupuncturist treat the individual rather than simply treat the condition, but the health of the individual can seriously affect the speed with which something can clear up, or indeed whether it can clear up. The best advice is to see a local practitioner for this kind of informal assessment before committing to treatment.

The one caution about treating anyone with MVP is that there is thought to be a known increase in risk of endocarditis if the skin is not cleaned before needles of any kind are inserted, and there is an absolute embargo on the use of any form of retained needle. This is occasionally disputed, as in this paper

https://www.ncbi.nlm.nih.gov/pubmed/14620303

but we always advise our members to treat people with heart valve problems as though they were immuno-compromised

Q: I've read that acupuncture raises blood pressure in individuals with normal blood pressure. Does this always happen and if so, after treatment, does the blood pressure go back to normal?

A: We have looked carefully through all of the research databases and checked for anecdotal accounts on the web, but apart from people who have experienced a raised blood pressure as a nervous response to having treatment itself, there is no evidence to suggest that acupuncture would raise blood pressure in someone with a normal blood pressure. Clearly if someone has low blood pressure, treatment might have the effect of normalising it, but the primary effect of acupuncture on blood pressure is to lower it. This is a well attested outcome, and we have have seen thousands of patients over the years who have hypertension as a primary or secondary problem, many of whom have seen considerable improvements after treatment.

That is not to say that it cannot happen, and if you have come across some research which we have missed we would be very grateful for the reference. Things do change, and surprising results do emerge, but something as important as this would generally bubble to the surface quite quickly.

Our own fact sheet on hypertension is not as informative as some others we produce, and the evidence is not to the standard where we would be making specific claims for the benefits to be derived from treatment. Most of the studies, however, fail on methodological grounds, but all report a lowering of blood pressure with treatment.

A:  We have produced a factsheet on hypertension

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/acupuncture-and-hypertension.html

which we have to confess we found a little lukewarm. However, we were delighted to find that there have been a number of new studies published since the factsheet was written, two of which 

 https://www.ncbi.nlm.nih.gov/pubmed/20232615

https://www.ncbi.nlm.nih.gov/pubmed/23724695

make much more encouraging noises. However, the most recent systematic review

https://www.ncbi.nlm.nih.gov/pubmed/26207806

concludes that acupuncture treatment is probably more useful as an adjunct to the use of conventional medication, and that, surprise surprise, more research needs to be done with larger studies. Easier said than done in the West where very little research is funded by mainstream bodies. However, one day....

 From a Chinese medicine perspective there are a number of clearly defined patterns which generate hypertension and where there are well-established protocols for lowering blood pressure, usually described from the external signs - the ancient Chinese did not have sphygmomanometers. When we come across new patients with these kinds of symptoms patterns we are usually confident of being able to offer some help. However, we always work as closely as we can with their doctors, whether directly or indirectly, to ensure that any reduction in medication is managed carefully. We have seen enthusiastic patients stop taking their meds in their desire to use a more natural method of B control and watched their BPs go through the roof. This is not what we want to see; the risk is too great.

 As far as snoring is concerned, there is very little research about snoring per se. There is quite a bit about obstructive sleep apnea, and we suspect that if your GP is aware of your BP problems and the snoring that investigations have been done to assess whether the snoring is part of the sleep apnea and contributing in part to the higher BP. Otherwise we have to be honest and say that when we take on patients with a problem like snoring, we tend to do so with the caveat that we will use our skills to balance things as well as we can from a Chinese medicine perspective and see what effect this has. However, we tend to set a tight limit on how many sessions we will do as an experiment, and we always look for a decent measurable outcome so that it is clear whether the treatment is working or not. This can be a problem; the sufferer is usually blissfully ignorant of the effect they are having.


A:  As far as we are aware there are no contraindications for the use of acupuncture, either traditional or auricular, with patients who have cardiomyopathy. In fact, if you undertake internet searches you will find a number of papers, most written in Chinese and published in China, which suggest that acupuncture treatment can be used to good effect in the treatment of some aspects of cardiomyopathy. The studies we found tend to use auricular acupuncture.

The normal safety standards which apply to the use of auricular acupuncture should be perfectly adequate for the protection of the patient with this condition, and the only slight concern we have raised in our members' Guide to Safe Practice is the use of retained needles when a patient has a history of heart valve problems. The section reads:

Patients who have damaged heart valves (eg after rheumatic fever) or artificial valves are at a higher risk of developing endocarditis. Retained needles, a category which includes ear needles, dermal needles and press studs which can be left in place for days, are contraindicated for these patients as they can become infected and cause endocarditis.

This is a very different kind of condition, so unless there is a secondary problem beyond the cardiomyopathy there is no reason not to proceed. 

We did find, however, one study (reference 18) referred to in another article

http://www.itmonline.org/arts/pc6.htm

which suggested that in one case there had been unwanted changes as a consequence of treating specific points, so if you have any concerns about the patient based on his or her presentation you could always, with their consent, approach their GP to ensure that it is OK to treat. This is the advice which we invariably give to BAcC members if they are not sure.




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