Do you sometimes feel your heart beating so fast that you feel scared, or the rhythm of your heartbeat seems to be out of sync? Just like when you play a drum, your heart suddenly starts beating faster, slower, or skips a beat. Today we are talking about a special treatment that doctors use in such cases. This is called 'Chemical Cardioversion'. Although the name is a bit complicated, the meaning of this is very simple.
Simply put, what is Chemical Cardioversion?
Chemical Cardioversion is a procedure that uses medications to restore an abnormal heart rhythm to a normal rhythm. It's like a traffic police officer coming to control a chaotic traffic jam and directing the vehicles in an orderly manner. Here, the 'traffic police officer' is the medicine that the doctor gives you.
The success of this treatment depends on several factors, such as what is causing your irregular heartbeat, how long you have had the condition, and what type of medication your doctor chooses.
The medications given for this treatment do several main things:
- It opens up your blood vessels a bit, making blood flow easier.
- Relaxes the heart muscles.
- It reduces the burden on the heart, that is, the workload of the heart.
- It controls the speed of electrical signals that signal the heart to beat.
Normally, our heartbeat starts in a very organized way. This electrical signal is initiated by a natural pacemaker in the heart called the sinoatrial node. This signal then travels through the parts of the heart in an orderly manner, causing the heart to contract properly and pump blood. If there is a problem with the way these signals travel, the heart rhythm becomes abnormal.
When the heart's rhythm is disturbed, it doesn't pump blood properly throughout the body. Our brain cells, like all other cells, need oxygen. This oxygen is carried by the blood. So when blood flow is reduced, symptoms such as dizziness (vertigo), fatigue, shortness of breath, and chest pain can occur.
Why do we need this treatment?
If your heart beats very fast or has an irregular rhythm, you may need chemical cardioversion. There are many reasons why your heart rhythm can become irregular. Imagine that your friend Nimal suddenly started feeling his chest pounding. It was only when he went to a doctor that he learned that a severe infection had affected his heart rhythm.
And there are many other reasons:
- Some medications you take: Some medications can cause changes in heart rhythm as a side effect.
- Infections: Bacterial or viral infections can affect the heart muscle.
- Heart Attack: A heart attack can damage the heart's electrical system.
- Changes in the structure of the heart: congenital heart disease or changes that occur later.
- Pulmonary Embolism: This is an emergency.
- Congestive Heart Failure: When the heart becomes weak and its ability to pump blood decreases.
- Lung diseases: Conditions like COPD or Emphysema.
What types of heart rhythms can be treated with this method?
Chemical cardioversion is used to treat a variety of abnormal heart rhythms, including:
| Abnormal heart rhythm name (Arrhythmia Name) | Simple explanation |
|---|---|
| Atrial Fibrillation (Afib) | A common condition in which the upper chambers of the heart (atria) beat very rapidly and irregularly. |
| Atrial Flutter | The upper chambers of the heart beat faster, but in a more organized rhythm than in Afib. |
| Supraventricular Tachycardia (SVT) | A very rapid heartbeat that starts in the upper part of the heart. |
| Ventricular Tachycardia (VT) | A rapid heartbeat that starts in the lower chambers (ventricles) of the heart. This can be serious. |
The difference between Electrical Cardioversion and this
You've probably seen it in the movies, where they give a shock to the chest to restart the heart. It's called 'Electrical Cardioversion.' It involves sending a controlled electric shock to the heart to 'reset' the electrical system. Chemical Cardioversion involves giving medication to do the same thing.
Your doctor will determine the best treatment for you based on your condition. For example, if your blood pressure is very low, your doctor may decide to perform electrical cardioversion.
What happens before treatment and how should we prepare?
Your doctor will give you some instructions before this treatment. It is very important to follow them exactly.
1. Avoiding food and drink: You will be asked to avoid eating or drinking anything for about 8 hours before the treatment.
2. Check for Blood Clots: If your heart has been irregular for more than two days, there is a chance that small blood clots may form inside your heart. If your heart rate suddenly returns to normal after this treatment, if the clot breaks loose and gets stuck in a blood vessel in your brain, it can cause a serious condition like a stroke. To check for that risk, your doctor may ask you to have a special scan called a Transesophageal Echocardiogram (TEE) . This involves inserting a small tube down your throat and looking very clearly at the back of your heart to see if there are any blood clots.
3. Anticoagulants: To reduce the risk of blood clots mentioned above, you will be asked to start taking blood thinners about 3 weeks before treatment. You will need to continue taking these medications for about 4 weeks after treatment.
4. Tell your doctor about all the medications you take: It is essential to tell your doctor about all the medications you take, including over-the-counter pain relievers, vitamins, and herbal remedies. Some medications may interact with the medications given for this treatment.
What happens during treatment?
This is not something you can do at home. You will be admitted to a hospital and given this treatment under constant supervision.
- Location: You will be admitted to the hospital's intensive care unit (ICU) or a similar ward where you can be closely monitored. Don't worry, this is for your safety. Because you need to be closely monitored for changes in your heart rhythm when you are given the medication.
- Monitoring: An IV line (cannula) will be placed in your arm and a monitor will be connected to it. This will continuously monitor your ECG (electrical activity of the heart), blood pressure, and oxygen levels.
- How the medicine is given: You will be given the medicine either as a pill to take by mouth or directly into a vein through an IV line in your arm. Sometimes, if the first dose doesn't work, you may be given another dose.
- Safety: Doctors and nursing staff are right there with you. They also have equipment like a defibrillator nearby in case of any other abnormal rhythm. So you are in a very safe environment.
What medications are used for this?
The medicine your doctor gives you will depend on the type of abnormal heart rhythm you have. Some of these medicines are used to treat high blood pressure and congestive heart failure.
Here are some of the main types of medications used:
- Adenosine
- Amiodarone
- Procainamide
- Ibutilide
- Beta-blockers - e.g. Metoprolol
- Calcium channel blockers - e.g. Diltiazem
- Flecainide
- Propafenone
Each of these medications works differently, so only your doctor can choose the medication that is best for you.
What happens after treatment?
After the medication is given and your heart rate returns to normal, you may be kept in the hospital for another 24 to 48 hours under observation to make sure everything is stable. After that, you can go home.
Many people report feeling tired and uncomfortable with the medication they are given. This is normal, but if you are having any major discomfort, please tell your doctor.
What are the risks and benefits of this treatment?
Like any medical treatment, there are both benefits and risks. Your doctor will only recommend this treatment if the benefits outweigh the risks.
| Advantages | Risks/Complications |
|---|---|
| Being able to bring the heartbeat back to a normal rhythm. | A new abnormal rhythm may develop or an existing one may worsen. |
| Reduction in symptoms such as dizziness, fatigue, and shortness of breath. | There is a small risk of a blood clot breaking loose and causing a stroke (this can be reduced with blood thinners). |
| An alternative to Electrical Cardioversion (the method of giving a shock). | Side effects such as nausea and fatigue may occur. |
| Some medications can take months to work. | |
| If treatment is not successful , other treatments such as Electrical Cardioversion or Catheter Ablation may be required. |
When do you need to see a doctor urgently?
When you go home after treatment, it is very important to be aware of any unusual symptoms. If you experience any of the symptoms below, go to the nearest hospital Emergency Department (ETU) immediately or call 1990.
- Heart palpitations
- Severe dizziness
- If your eyes become blue and you feel lightheaded (Lightheadedness)
- Weakness
- Sudden excessive sweating (Sweatiness)
- Allergic reactions such as rash and itching
- Chest pain
- Difficulty breathing
Before and after treatment, take all medications prescribed by your doctor exactly and on time. If you have any doubts about how to take your medication, ask your doctor again for clarification.
Take-Home Message
- Chemical cardioversion is a treatment that uses medication to restore the heart's rhythm to normal.
- This is done to ensure your safety, in a hospital, under constant medical supervision.
- Before treatment, it is imperative to inform your doctor about all medications you are taking, including vitamins and Ayurvedic medicines.
- As with all treatments, there are some risks, but your doctor is prescribing this treatment for you because the benefits far outweigh the risks.
- After treatment, it is very important to take medications, especially blood thinners, exactly as prescribed.
- Seek immediate medical attention if you experience emergency symptoms such as chest pain, difficulty breathing, or severe dizziness.
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