Cardioversion
Cardioversion
Cardioversion
ON
CARDIOVERSION
Presented To Presented By
Dr. Shaveta Sharma Deeksha
Professor MSN M.sc(N)2nd year
SNI, Kurali Medical Surgical Nursing
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INTRODUCTION
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DEFINITION
• Cardioversion is a synchronized
administration of shock during the R
waves or QRS complex of a cardiac
cycle and restore a rapid heart beat
back to normal.
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INDICATION
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TYPES OF CARDIOVERSION
Chemical Electrical
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CHEMICAL CARDIOVERSION
Class I
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Class II
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Class III
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Class IV
• These drugs are calcium (Ca) channel
blockers. They work by inhibiting the
action potential of the SA and AV
nodes.
• E.g. Diltiazem
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ELECTRIC CARDIOVERSION
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BASIC PRINCIPLES
• Transient delivery of electrical current
causes a momentary depolarization of
most cardiac cells allowing the sinus
node to resume normal pacemaker
activity.
• In the presence of reentrant-induced
arrhythmia, such as PSVT and VT,
electrical cardioversion interrupts the
self- perpetuating circuit and restores
a sinus rhythm.
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CONTRAINDICATION
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External cardioversion
Internal cardioversion
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EXTERNAL CARDIOVERSION
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Cont.......
• Synchronization to an R or S wave
prevents the delivery of a shock
during the vulnerable period of cardiac
repolarization when ventricular
fibrillation can be induced.
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Cont.......
• Synchronized electrical cardioversion
may also be used to treat stable
ventricular tachycardia (VT, vtach) that
does not respond to a trial of
intravenous medications. It is also
recommended for the treatment of the
following arrhythmias :
• Supraventricular tachycardia (SVT) due
to reentry
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Cont........
• Atrial fibrillation
• Atrial flutter
• Atrial tachycardia
• Monomorphic ventricular tachycardia
with pulses
• https://youtu.be/dC_i8zuclmQ
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• Monitor
• Defibrillator
• Connecting media marred
defibrillator pads
• Emergency cart and
medications
• Emergency pacing equipment
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PROCEDURE
• The patient should be connected to
monitor and a rhythm strip obtained in
order to verify the type of tacky
dysrhythmias the patient.
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Cont.........
• Rule out hypotension, chest pain,
altered mental status, shortness of
breath, shock or other conditions
which may be related to tachycardia.
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Cont........
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Cont....
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Cont.....
• Positioned in paddles on the patient by
that apply one at apex to the left of the
nipple in the mid axillary line and other
just below the right clavicle to the
right of the sternum.
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Cont....
• The electrocardiogram recorder should
be on.
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Cont.......
• This decrease is intrathoracic
resistance and improves the flow of
current across axis of the heart.
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Cont.....
• If ventricular fibrillation or pulse less
ventricular tachycardia develops,
deactivate the synch button, and
follow the procedures for defibrillation.
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INTERNAL CARDIOVERSION
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Cont.......
• The catheter is temporarily inserted
into your heart through a vein, in your
groin, neck or arm.
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Cont........
• After the catheter is correctly
positioned, the catheter is connected
to the Energy Delivery Device, and one
or more low energy shocks of less than
30J will be given to convert your heart
into a normal rhythm.
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Cont....
• The whole procedure takes place in
about 30 minutes and do not usually
require a general anesthetic though
heavy sedation is required.
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COMPLICATIONS
• Provocation of other fast or slow
arrhythmias
• Sedation related complications:
Aspiration
• Skin Burn/Irritation
• A stroke can occur when the shock
either causes a clot that is already
present to travel to the brain or
elsewhere throughout the body, or
results in formation of a new clot after
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Cont.......
• For that client receiving digoxin, a
therapeutic drug level must be
maintained.
• Self adhesive pads are used and
placed in the standard apex anterior or
apex posterior positions.
• The client is premedicated with the
rapid short acting sedative.
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Cont......
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Cont.....
• While standing back from the bed
depresses and hold s the buttons of the
paddles until the shock is delivered.
• Reassess the cardiac rhythm, rate, BP
and pulse oxymetry and client’s airway
after every shock delivered.
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Cont.....
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BIBLIOGRAPHY
• Hariprasath P. Textbook of
cardiovascular and thoracic nursing.
First. Vol. 1. New delhi: jaypee; page
no. 290-299
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Cont.....
• Cardioversion - Mayo Clinic [Internet].
Available from:
https://www.mayoclinic.org/tests-proce
dures/cardioversion/about/pac-2038512
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Cont.......
• Cardioversion (for Atrial Fibrillation)
[Internet]. 2010. Available from:
https://www.youtube.com/watch?v=dC_
i8zuclmQ
THANKYOU
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