Download Internal Cardioversion book (Printable Version) - University

WELCOME TO THE GLENFIELD CARDIOLOGY UNIT
HAS MY CARDIOVERSION BEEN SUCCESSFUL?
You have been asked to attend the ward to have an elective
internal elective Cardioversion. This booklet has been designed
to help you understand about your forthcoming procedure.
Hopefully it will answer any queries and alleviate any fears you
may be experiencing.
Your consultant/senior doctor who performed
the cardioversion will see you on the ward
and explain in full the result of your
cardioversion also at this time they will
discuss
further
treatment/change
in
medication if necessary.
If you have any questions, do not hesitate to ask your Named
Nurse who will be looking after you.
WHAT IS CARDIOVERSION?
To understand what an internal cardioversion is, you must first
understand the normal heart rhythm and also understand the
abnormal rhythm that you may be experiencing.
NORMAL HEART RHYTHM
Normally the signal that tells the heart to beat comes from a group
of pacemaker cells in the heart called the sino atrial node (SA
node). This starts electrical activity that produces contraction of
the two atria (upper heart chambers) and two ventricles (lower
heart chambers). The contraction of the heart produces the
heartbeat and blood is forced out into the arteries of the body. In
most people the heart rate at rest is between 60-80 beats per
minute.
When we exercise or are under stress, the pacemaker speeds up
its rate of discharge of electrical activity as it responds to nervous
and chemical influences in the body. Individuals can often feel
this increase and are aware of this fast heart rate. When the
exercise ceases or when the individual is less stressed, the heart
slows to its usual rate.
-1 -
GOING HOME
Before going home your nurse will remove the needle in your
hand and will give you a discharge letter to give to your GP. You
will also be given a letter with appointment to return to clinic for an
ECG one week post internal cardioversion.
You will also be given advice
regarding care of your wound and
physical activities. It is important to
arrange for a family member or friend
to collect you from the ward to drive
you home.
Occasionally your original symptoms may reoccur following
discharge. If you have any worries experience further palpitations
or you feel unwell, please contact your GP
www.yourheart.org.uk is one of the first interactive web sites for
heart patients and their relatives and friends in the UK. This site
will offer heart and health related information available.
-6-
RISKS
 Bruising in the groin is common following this procedure.
However this usually disappears within a week and does not
cause a problem.
 Remaining in A/F or reverting back to A/F after a short time.
 Minor groin complications of bleeding bruising are common
occurring 1 in 5 cases (20%). With more serious damage to
the artery or veins occurring in 1 in 100 cases.
BENEFITS OF A SUCCESSFUL INTERNAL CARDIOVERSION
ABNORMAL HEART RHYTHM ie TACHYCARDIA
Your heart may revert back to a normal rhythm. If you remain in
sinus rhythm (normal heart rhythm) you will have the benefit of not
having to take lifelong Warfarin. If you experienced symptoms
associated to an irregular heart rhythm eg palpitations, shortness
of breath, these should be alleviated.
Occasionally, electrical signals arise in areas of the heart away
from the normal pacemaker (sino-atrial node). This may be in the
atria (atrial ectopic beats or atrial fibrillation), atrioventricular node
(AV nodal tachycardia) or ventricles (ventricular ectopic beats of
ventricular tachycardia). They produce a heartbeat, which comes
earlier than expected this is called an ectopic beat. This alone is
not dangerous and the effect on the heart is minimal.
Alternatively, a fast heartbeat that is persistent is called
tachycardia. This is usually caused by abnormal activation of the
heart in what is called a ‘re-entrant circuit’. If the heart rate is
increased to 150-200 beats per minute, the heart tends not to
work as effectively and the patient may feel unwell. The
experience of palpitations in this form can often be frightening to
the individual concerned.
ON RETURN TO THE WARD
On return to the ward you may still feel sleepy. A nurse will record
an ECG (tracing of the heart), blood pressure and pulse and feel
your feet to locate foot pulses. He/she will also check your groin
for any bleeding. When you are fully awake your nurse will help
you sit up. You will be able to eat and drink normally and a
welcome drink will be ready.
It is important to remain in bed for approximately 2 hours after the
catheter has been removed. It is also important to keep the
affected leg/groin as still as possible, this is to prevent any
bleeding from the catheter insertion site. If you feel unwell or
experience any palpitations after the treatment, please let the
nurse know.
-5-
These tachycardia/irregular heartbeats can be treated with special
drugs. If the drugs have been ineffective or are thought to be
unsuitable, one of the methods of treating the tachycardia is by a
process called Cardioversion.
CARDIOVERSION
Cardioversion is when an electrical shock is delivered to the heart.
The electrical shock interrupts the ‘re-entrant circuit’ that causes
the tachycardia and resets the heart back to its normal sequence.
-2-
PRE ADMISSION APPOINTMENT PRIOR TO PROCEDURE
WHAT DOES THE PROCEDURE INVOLVE?
The majority of out-patients attend our Pre admission Clinic
approximately one week prior to their admission date where the
pre admission sister will take a medical history/nursing
assessment and relevant investigations will be carried out
including blood tests. Also at this time a full explanation about
your procedure and your stay in hospital will be given.
When you arrive on the ward you will meet
the nurse who will be caring for you and
he/she will assist you in preparing for the
test. You will be asked to put on a
hospital gown and you will be offered a
pre medication tablet, which will help you
to feel more relaxed. A needle will be put
into the back of your hand. A sample of blood will also be taken to
check your INR level.
MEDICATION
If you are on tablets to control the rate of your heart beat you
should continue those unless advised otherwise. Full explanation
about your medication and instructions regarding taking
medication will be given at the time of your pre admission
appointment.
WARFARIN
Before undergoing internal cardioversion you must be taking
Warfarin. It is vitally important that the blood test result (INR) at
the time of procedure is between 2 and 3.5. You should have an
INR test two days before admission and inform whoever is taking
your blood test of your forthcoming procedure and the level of INR
that is required. This will help the doctor that is looking after your
Warfarin dosing to prescribe the correct dose in the 48 hour period
before the procedure.
The procedure is performed away from the ward in one of the
catheter rooms. The room contains the specialist x-ray and
monitoring equipment required for the procedure. The staff in this
department wear a blue tunic and trousers, gown and mask and
gloves as appropriate. On arrival at the catheter room you will be
transferred from your bed, trolley or chair to a table which is
narrow and firm. Heart monitoring (ECG) leads will be attached to
your arms and legs; your groin will be cleaned with an antiseptic
lotion and covered with sterile towels. A local anaesthetic will be
injected to numb the skin around the area where a sheath (a tube)
is inserted into a vein in the groin through which a cardioversion
catheter is then passed up to the right side of your heart.
You should not have anything to eat or drink for at least 4 hours
before the cardioversion procedure. Information regarding this will
be given at your pre admission appointment.
This catheter contains electrodes. One electrode is passed into
the pulmonary artery and one into the right atrium thus creating a
pathway for delivery of a low energy
shock. At this point sedation will be
given via the needle in your hand and
the shock will be delivered. When you
wake up after the internal cardioversion
has been completed you may feel
sleepy. The sheath inserted in the
groin to allow the catheter to be passed to the heart will be
removed at the end of the procedure.
-3-
-4-
Please bring your INR result and your Warfarin book with you
when you are admitted for the cardioversion.
PREPARATION FOR THE PROCEDURE
TRANSLATION
If you would like this information in another language or format,
please contact the Service Equality Manager on 0116 258 4382.
CARDIO RESPIRATORY DIRECTORATE
INTERNAL CARDIOVERSION
Haddaad rabto warqadan oo turjuman oo ku duuban cajalad ama
qoraal ah fadlan la xiriir, Maamulaha Adeegga Sinaanta 0116
2584382.
A PATIENT GUIDE
Eĝer bu broşürün (kitapçıĝın) yazılı veya kasetli açıklamasını
isterseniz lütfen servis müdürüne 0116 258 4382 telefonundan
ulaşabilirsiniz.
This booklet has been produced by:
The Cardio-Respiratory Patient Information Group
Originated: September 2001
Updated: June 2003
University Hospitals of Leicester NHS Trust
Glenfield Hospital
Groby Road
Leicester
LE3 9QP
University Hospitals of Leicester
NHS Trust
Telephone: 0300 303 1573
Fax: 0116 2583950
Minicom: 0116 2879852
Glenfield Hospital