DC Shock
DC Shock
DC Shock
Cardioversion(DC Shock)
17 Agustus 2015
1 Oktober 2016
Defibrillation is a procedure used to treat life threatening
conditions that affect the rhythm of the heart such as cardiac
arrhythmia, ventricular fibrillation and pulseless ventricular
tachycardia.
By Dr Ananya Mandal, MD
Defibrillation
A treatment of choice for ventricular fibrillations and pulseless
ventricular tachycardia, must be performed ASAP, even
before intubation or drug administration
Cardioversion
Delivers an electric shock to the heart to correct arrhythmias
Basic principles
Transient delivery of electrical current causes a momentary
depolarization of most cardiac cells allowing the sinus node to
resume normal pacemaker activity.
Serious complications include ventricular fibrillation (VF) resulting from high amounts of electrical energy, digitalis
toxicity, severe heart disease, or improper synchronization of the shock with the R wave.
Thromboembolization is associated with cardioversion in 1-3% of patients, especially in patients with atrial
fibrillation who have not been anticoagulated prior to cardioversion. Current American College of Cardiology
(ACC)/American Heart Association (AHA) guidelines recommend to anticoagulate for 3-4 weeks before and after
cardioversion. The presence of an intracardiac thrombus should be excluded using transesophageal
echocardiography prior to cardioversion if therapeutic anticoagulation has not been achieved.
Myocardial necrosis can result from high-energy shocks. ST segment elevation can be seen immediately and
usually lasts for 1-2 minutes. ST segment elevation that lasts longer than 2 minutes usually indicates myocardial
injury unrelated to the shock.
Myocardial dysfunction is due to an absence of cardiac output and coronary blood flow during arrest, resulting in
ischemia. Myocardial dysfunction due to stunning may reverse within first 24-48 hours. Left ventricle function
evaluation should be delayed for 48 hours after arrest.
Pulmonary edema is a rare complication of cardioversion. It is probably due to transient left atrial standstill and
left ventricular systolic dysfunction. It is more common in atrial fibrillation due to valvular heart disease or left
ventricular systolic dysfunction.
Painful skin burns can occur after cardioversion or defibrillation; they are moderate to severe in 20-25% of
patients. They most likely are due to improper technique and electrode placement. It occurs less with use of
biphasic waveform defibrillators and use of gel-based pads. Prophylactic use of steroid cream or topical
ibuprofen reduces pain and inflammation.