CARDIOVERSION

General Information:

What is it? Cardioversion (KAR-d-o-ver-shun) is when a machine called a defibrillator (d-FIB-rih-la-tur) gives a short electric shock to the heart. This shock is given at a certain time during the heartbeat to help your heartbeat return to normal.

How does the heart normally work? 

• The heart has 4 chambers or rooms called the right and left atria (A-tree-uh) and ventricles (VEN-trik-ulls). Blood vessels bring blood from your body to the right atrium in your heart. The blood moves into the right ventricle where it is pumped into the lungs to get oxygen. The oxygen-rich blood goes into the left atrium and down into the left ventricle. The left ventricle pumps the blood out to the body where the oxygen can be used.
  
• Special cells inside the heart send electrical impulses to the heart muscles telling the heart to beat. These cells are called pacemaker cells. A normal heart beats about 70 to 80 times a minute.
  

Why do you need cardioversion? Cardioversion may be needed if you have a cardiac arrhythmia (uh-RITH-me-uh). Arrhythmias are when the heart does not have a normal beat. Cardioversion can help stop the arrhythmia long enough to let the heart's normal pacemaker cells take over. Then the heartbeat can return to normal. Following are the 4 main types of arrhythmias that may be treated with cardioversion. 

• Atrial flutter
  
• Atrial fibrillation
  
• Supraventricular tachycardia
  
• Ventricular tachycardia

Care: 

• Heart medicine is usually used first to treat arrhythmias. If the medicine does not stop the arrhythmia, caregivers may then use cardioversion. Before having the cardioversion, you may have tests to make sure there are no blood clots in your heart. You may be given blood thinning medicine before having the cardioversion. You may also be given heart medicine for 1 to 2 days before being treated with cardioversion. This medicine is used to help make the heart sensitive to the electrical charge. This helps the heart change back to a normal beat during the cardioversion.
  
• If possible, you will be given medicine to help you relax before the cardioversion. If the shock works, your heart rate and rhythm will return to normal. You may go home the same day or you may stay in the hospital overnight. You may need to take medicines afterward to control your heart rate and to thin your blood.

GETTING READY:

The Week Before Your Cardioversion: 

• Ask your caregiver if you need to stop taking aspirin or any other blood thinning medicines before your procedure.
  
• Ask your caregiver before taking any over-the-counter medicine, vitamins, herbs, food supplements, or laxatives.
  
• You may be given heart medicine for 1 to 2 days before being treated with cardioversion. This medicine is used to help make the heart sensitive to the electrical charge. This helps the heart change back to a normal beat during cardioversion.
  
• You may need blood tests before your procedure. Talk to your caregiver about these or other tests you may need. Write down the date, time and location for each test.
  
• You may also need a test to make sure there are no blood clots in the heart. Talk to your caregiver about these or other tests you may need. Write down the date, time and location for each test.
  
• You may also be given blood thinning medicine before having the cardioversion.

The Night Before Your Cardioversion: 

• You may be given a pill to take to help you sleep.
  
• Ask caregivers about directions for eating and drinking.

The Day Of Your Cardioversion: 

• Write down the correct date, time, and location of your procedure.
  

• Ask your caregiver before taking any medicine on the day of cardioversion. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring a list of your medicines or the pill bottles with you to the hospital.

• Do not wear contact lenses the day of the cardioversion. You may wear your glasses.
  
• If you are staying in the hospital after cardioversion, bring your personal belongings with you. These include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers. Do not wear jewelry or bring money to the hospital.
  
• An anesthesiologist (an-iss-thee-z-ALL-o-jist) may talk to you before your cardioversion. This is the caregiver who gives you medicine to make you sleepy during cardioversion.
  
• Make sure you have signed an informed consent. You or a close family member may be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do a cardioversion. Be sure all your questions have been answered before you sign this form.

• What Will Happen:You will be asked to change into a hospital gown. You may be given medicine in your IV to help you relax or make you drowsy. This medicine makes it so you cannot remember having the cardioversion. You will be taken to the room where the cardioversion will be done. You may be given extra oxygen through a thin tube in your nose or a mask over your face. An EKG test may be done to watch your heartbeat before and after the cardioversion.

After Your Cardioversion:You will be taken to a recovery room. You will be there until you are fully awake. You may then be able to go home or will be taken back to your room. Do not get out of bed until your caregiver says it is OK.

Waiting Room:Your family can wait in the waiting room until the cardioversion is done. Your doctor or nurse can find them to let them know how the cardioversion went. If your family leaves, ask them to leave a phone number where they can be reached. Someone should drive you home when it is time for you to leave. Do not drive home alone.

• You cannot make it to your cardioversion appointment on time.
  
• You have questions or concerns about cardioversion.
  
• You have a fever (increased body temperature). The cardioversion may need to be done later when you are well.
  
• The problems for which you are having the cardioversion get worse.

RISKS:

• It is very rare to have problems caused by cardioversion. With some arrhythmias, blood stays in the heart too long and blood clots can form. Cardioversion can cause these clots to break away and travel through the blood. If a clot gets stuck in a small blood vessel, the tissue beyond the clot cannot get enough blood. The tissue may then start to die, which is called an infarction (in-FARK-shun). If a clot travels to the brain it can cause a stroke. Even with cardioversion your heartbeat may not return to normal.
  
  
• Even with cardioversion, your heartbeat may not return to normal. Sometimes after successful cardioversion, your heart may return to the abnormal heartbeat.
  

WHILE YOU ARE HERE:

Before Your Cardioversion: 

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
• Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  
• Gown: A hospital gown is needed so that caregivers can easily check and treat you. Caregivers will show you how to put on your gown. You may not be allowed to wear your own bedclothes or undergarments to the operating room. This is because you may need monitors on your skin during surgery. When you feel better you may be able to wear your own bedclothes.
  
• Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
  
• IV: An IV (intravenous) is a tube placed in your vein that is used to give you medicine or liquids.
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
• Pre-Op Care: Pre-Op care is the care you get right before your cardioversion. You may be given extra oxygen before and after cardioversion. It is given through a plastic mask over your mouth and nose. It can also be given through nasal prongs (short, thin tubes in your nose). You may be given IV medicines before the cardioversion to make you sleep and not remember the procedure. You are taken on a cart to the room where your surgery will be done. Caregivers help you get comfortable on the bed and put a belt over your legs for safety.
  
• Oxygen: You may be given extra oxygen to help you breathe easier during the cardioversion. It may be given through a plastic mask over your mouth and nose. Oxygen may be also be given through nasal prongs (short, thin tubes in your nose).
  
• Medicines: You may be given the following medicines before, during, or after your cardioversion.
  
  
  • Anti-anxiety medicine: This medicine may be given to help you feel less nervous and more relaxed.
    
    
  • Blood thinners: This medicine helps stop clots from forming in your blood. Blood thinners may be given before, during, and after a surgery or procedure. Blood thinners make it easier for you to bleed or bruise. If you shave, use an electric shaver. Use a soft toothbrush to help keep your gums from bleeding.
    
    
  • Heart Medicine: This medicine may be given to make your heart beat better or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it. You may need to take heart medicine for the rest of your life.

During Your Cardioversion:Paddles or pads are placed on your chest. Caregivers may put gel on your skin where the paddles are placed and put firm pressure on the paddles. This helps the electrical charge go into your body better. Several shocks may be needed to return your heartbeat to normal.

After Your Cardioversion:You are taken to a room where you can rest until you are fully awake. You may then be able to go home. Or, if you are staying in the hospital you may be taken back to your room. Do not get out of bed until your caregiver says it is OK. You may be given extra oxygen after the procedure. Another 12-lead EKG may be taken to check your heartbeat.

• Medicines:

  • Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicine. Do not use any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without first talking to caregivers.
    
  • Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment.
  • Aspirin to stop blood clots: Aspirin helps thin the blood to keep blood clots from forming. If caregivers tell you to take aspirin, do not take acetaminophen or ibuprofen instead. Do not take more or less aspirin than caregivers say to take.
    
  • Heart Medicine:You may be given heart medicine to make your heart beat better or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it.
    
  • Blood thinners: Blood thinners are medicines that help prevent clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners may cause you to bleed or bruise more easily. If you are taking a blood thinner:
    
    
    • Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. Doing this can keep your skin and gums from bleeding. Tell your dentist and other caregivers that you take blood thinning medicine.
      
    • If you shave, use an electric shaver. Do not play contact sports since this medicine makes you bruise and bleed easily. Wear a bracelet or necklace that says you are taking blood thinning medicine.

  When is my next medical appointment? 

  Ask your caregiver when to return for a follow-up visit. Keep all appointments. Write down any questions you may have. This way you will remember to ask these questions during your next visit.

  When can I do my normal activities? 
  

  • You may feel like resting more after the cardioversion. Slowly start to do more each day. Rest when you feel it is needed.
    
  • Avoid lifting heavy objects.
    
  • Ask your caregiver when you can start driving, and return to work or school.
    
  • You may have sex when you feel ready. Stop if it causes pain. Talk to your caregiver if you have questions or concerns.

  What can I eat after my cardioversion? 
  

  • You may be told to eat foods that are low in fat. Ask for the "Low Fat Diet" CareNotes™ handout for more information.
    
  • You may also be told to limit the amount of salt you eat. This may mean you should not add salt to your food during meals or when you cook.
    
  • It can take time getting used to a new diet. Special cookbooks may help the cook in the family find new recipes.

  Wellness hints: 

  • Follow a healthy diet:
    
    • Eat a variety of healthy foods such as fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meat and fish. Eating healthy foods may help you have more energy and heal faster. Ask your caregiver if you need to be on a special diet.
      
    • Men 19 years old and older should drink about 3 liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 liters of liquid each day (close to 9 eight-ounce cups). Follow your caregiver's advice if you must change the amount of liquid you drink. For most people, good liquids to drink are water, juices, and milk. If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Try to drink enough liquid each day, and not just when you feel thirsty.
      
  • Start exercising: Talk to your caregiver before you start exercising. Together you can plan the best exercise program for you. It is best to start slowly and do more as you get stronger. Exercising can help make your heart stronger, lower your blood pressure, and keep you healthy.
    
  • Quit smoking: It is never too late to quit smoking. Smoking harms your body in many ways. You are more likely to have heart disease, lung disease, cancer, and other health problems if you smoke. Quitting smoking will improve your health and the health of those around you. Ask your caregiver for more information about how to stop smoking if you are having trouble quitting.
    
  • Avoid stress: Stress may slow healing and cause illness. Since it is hard to avoid stress, learn to control it. Learn new ways to relax, such as deep breathing. Talk to your caregiver about things that upset you.

  CONTACT A CAREGIVER IF:

  • You have a fever (increased body temperature).
    
  • You have chills, a cough, or feel weak and achy. These are signs that you may have an infection.
    
  • Your skin is itchy, swollen, or has a rash. Your medicine may be causing these symptoms. This may mean you are allergic (uh-LER-jik) to your medicine.
    
  • You have chest pain, palpitations, faintness, or other new or unexplained symptoms.
    
  • Your heart problems symptoms return or get worse.
    
  • You have questions or concerns about your heart problem, cardioversion, or medicine.

  SEEK CARE IMMEDIATELY IF:

  • You have trouble breathing all of a sudden. This could be a sign that you have a blood clot in your lung. It could also mean that you are allergic to a medicine you are taking.
    
  • You feel that your heartbeat is not regular, too fast, or too slow.
    
  • You have 1 or more of these signs or symptoms of a stroke. These signs and symptoms may happen all of a sudden:
    
    
    • A very bad headache.
      
    • Trouble walking or loss of balance. Also if you are too dizzy to walk.
      
    • Weakness or numbness in your arm, leg, or face, especially on one side of your body.
      
    • Confusion and have trouble speaking or understanding things.
      
    • Cannot see out of one or both of your eyes.
      
    • This is an emergency. Call 911 or 0 (operator) for an ambulance to get to the nearest hospital. Do not drive yourself!
    
    
  • You have signs or symptoms of a heart attack:
    
    
    • Chest pain or discomfort that spreads to your arms, jaw, or back.
      
    • New, sudden back pain.
      
    • Nausea (feeling sick to your stomach).
      
    • Trouble breathing.
      
    • Sweating.
      
    • Lips or nailbeds that turn blue or white in color.
      
    • This is an emergency. Call 911 or 0 (operator) for an ambulance to get to the nearest hospital or clinic. Do not drive yourself!

  
  

  
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