Acupuncture is considered a relatively safe procedure. However, there are serious adverse effects; neurological damage, pneumothorax, cardiac tamponade, serum hepatitis, bacterial and viral infections may occur. Cardiac tamponade is considered to be a rare adverse effect of acupuncture. In the following case, cardiac tamponade was caused by epigastric acupuncture. A 78-year-old male was admitted with a chief complaint of drowsy mentality and hypotension, suggesting a status of shock. He had received acupuncture therapy over epigastric area for gastric dyspepsia at a local oriental medical clinic. An abdominal CT scan and chest x-ray showed a hemopericardium. After receiving pericardiocentesis, his clinical condition improved immediately. He was short in stature and slender for his age. Chest x-ray and computed tomography showed cardiomegaly and pectus excavatum. A proper use of acupuncture by a skilled medical provider is essential to avoid serious complications.