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Asystole
 
 
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In medicine, asystole (colloquially known as flatline) is a state of no cardiac
Heart

The heart is a muscle organ in all vertebrates responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in annelids, mollusks, and arthropods....
 electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. Asystole is one of the conditions required for a medical practitioner to certify death
Death

Death is the permanent termination of the biological functions that define a life organism. It refers to both a particular event and to the condition that results thereby....
.

When a patient displays asystole, the treatment of choice is an injection of epinephrine
Epinephrine

Epinephrine is a hormone and neurotransmitter.Epinephrine increases the "fight or flight" response of the Sympathetic nervous system of the autonomic nervous system....
 and atropine (vasopressin may also be used) and chest compressions. In asystole, the heart will not respond to defibrillation
Defibrillation

Defibrillation is the definitive treatment for the life-threatening cardiac arrhythmias, ventricular fibrillation and ventricular tachycardia....
 because it is already depolarized
Depolarization

In biology, depolarization is a decrease in the absolute value of a cell's membrane potential. Thus, changes in membrane voltage in which the membrane potential becomes less positive or less negative are both depolarizations....
.






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In medicine, asystole (colloquially known as flatline) is a state of no cardiac
Heart

The heart is a muscle organ in all vertebrates responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in annelids, mollusks, and arthropods....
 electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. Asystole is one of the conditions required for a medical practitioner to certify death
Death

Death is the permanent termination of the biological functions that define a life organism. It refers to both a particular event and to the condition that results thereby....
.

When a patient displays asystole, the treatment of choice is an injection of epinephrine
Epinephrine

Epinephrine is a hormone and neurotransmitter.Epinephrine increases the "fight or flight" response of the Sympathetic nervous system of the autonomic nervous system....
 and atropine (vasopressin may also be used) and chest compressions. In asystole, the heart will not respond to defibrillation
Defibrillation

Defibrillation is the definitive treatment for the life-threatening cardiac arrhythmias, ventricular fibrillation and ventricular tachycardia....
 because it is already depolarized
Depolarization

In biology, depolarization is a decrease in the absolute value of a cell's membrane potential. Thus, changes in membrane voltage in which the membrane potential becomes less positive or less negative are both depolarizations....
. However, some emergency physicians advocate a trial of defibrillation in case the rhythm is actually fine ventricular fibrillation
Ventricular fibrillation

Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricle s in the heart, making them tremble rather than contract properly....
, although little evidence exists to support the practice. Asystole is usually a confirmation of death as opposed to a heart rhythm to be treated, although a small minority of patients are successfully resuscitated, if the underlying cause is identified and treated immediately.

Possible underlying causes include the Hs and Ts.

  • Hypovolemia
    Hypovolemia

    In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. Volumetric thirst can be caused by a number of things including bleeding and diarrhea....
  • Hypoxia
    Hypoxia (medical)

    Hypoxia is a Pathology condition in which the body as a whole or a region of the body is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise....
  • Hydrogen
    Hydrogen

    Hydrogen is the chemical element with atomic number 1. It is represented by the chemical symbol H. At standard temperature and pressure, hydrogen is a colorless, odorless, nonmetallic, tasteless, highly combustion and explosive Diatomic molecule gas with the molecular formula H2....
     ions (Acidosis
    Acidosis

    Acidosis is an increased acidity . If not further qualified, it usually refers to acidity of the blood plasma.Acidosis is said to occur when arterial pH falls below 7.35, while its counterpart occurs at a pH over 7.45....
    )
  • Hypothermia
    Hypothermia

    Hypothermia is a condition in which an organism's temperature drops below that required for normal metabolism and bodily functions. In warm-blooded animals, core body temperature is maintained near a constant level through biologic homeostasis....
  • Hyperkalemia
    Hyperkalemia

    Hyperkalemia Hyperkalaemia is an elevated blood level of the electrolyte potassium. The prefix hyper- means high . The middle kal refers to kalium, which is neo-Latin for potassium....
     or Hypokalemia
    Hypokalemia

    Hypokalemia refers to the condition in which the concentration of potassium in the blood is low. The prefix hypo- means low . Kal refers to kalium, the Neo-Latin for potassium, and -emia means "in the blood."...
  • Hypoglycemia
    Hypoglycemia

    Hypoglycaemia or hypoglycemia is the medical term for a Pathology state produced by a lower than normal level of Blood glucose. The term hypoglycemia literally means "under-sweet blood" ....
  • Tablets or Toxins (Drug overdose
    Drug overdose

    The term drug overdose describes the ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced....
    )
  • Cardiac Tamponade
    Cardiac tamponade

    Cardiac tamponade, also known as pericardial tamponade, is an medical emergency condition in which fluid accumulates in the pericardium . If the fluid significantly elevates the pressure on the heart it will prevent the Ventricle from filling properly....
  • Tension pneumothorax
    Tension pneumothorax

    A tension pneumothorax is a life-threatening condition that results from a progressive deterioration and worsening of a simple pneumothorax, associated with the formation of a Check valve at the point of a rupture in the lung....
  • Thrombosis
    Thrombosis

    Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot, because the first step in repairing it is to prevent loss of blood....
     (Myocardial infarction
    Myocardial infarction

    Myocardial infarction , commonly known as a heart attack, occurs when the Blood flow to part of the heart is interrupted. This is most commonly due to occlusion of a coronary artery following the rupture of a Vulnerable plaque, which is an unstable collection of lipids and white blood cells in the wall of an artery....
    )
  • Thrombosis
    Thrombosis

    Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot, because the first step in repairing it is to prevent loss of blood....
     (Pulmonary embolism
    Pulmonary embolism

    Pulmonary embolism is a blockage of the pulmonary artery or one of its branches, usually occurring when a deep vein thrombosis becomes dislodged from its site of formation and travels, or embolism, to the pulmonary artery blood supply of one of the lungs....
    )
  • Trauma
    Physical trauma

    Physical trauma refers to a body injury. A trauma patient is someone who has suffered serious and life-threatening physical injury with the potential for secondary complications such as Shock , respiratory failure and death....
     (Hypovolemia
    Hypovolemia

    In physiology and medicine, hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. Volumetric thirst can be caused by a number of things including bleeding and diarrhea....
     from blood loss)


While the heart is asystolic, there is no blood flow to the brain unless CPR
Cardiopulmonary resuscitation

Cardiopulmonary resuscitation is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest. CPR is performed in hospitals, or in the community by layman or by emergency response professionals....
 or internal cardiac massage (when the chest is opened and the heart is manually compressed) is performed, and even then, it is still a small amount. After many emergency treatments have been applied but the heart is still unresponsive, it is time to consider pronouncing the patient dead. Even in the rare case that a rhythm should reappear, if asystole has persisted for fifteen minutes or more the brain will have been deprived of oxygen long enough to cause brain death
Brain death

Brain death isa legal definition of death that emerged in the 1960s as a response to the ability to resuscitate individuals and mechanically keep the heart and lungs working....
.

See also

  • Cardiac arrest
    Cardiac arrest

    A cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during Systole ....
  • Myocardial infarction
    Myocardial infarction

    Myocardial infarction , commonly known as a heart attack, occurs when the Blood flow to part of the heart is interrupted. This is most commonly due to occlusion of a coronary artery following the rupture of a Vulnerable plaque, which is an unstable collection of lipids and white blood cells in the wall of an artery....
  • Ventricular fibrillation
    Ventricular fibrillation

    Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricle s in the heart, making them tremble rather than contract properly....