Asystole is the complete absence of heart rhythm, often resulting in death. It can be caused by heart damage or disease, and is treated with drugs, chest compressions, and pacing. Prolonged asystole can cause brain damage, and recovery is rare.
Asystole is a complete absence of heart rhythm. When the heart is in asystole, it has stopped beating or the electrical activity is occurring at such a low level that it cannot be detected with an electrocardiograph. Most people who develop asystole die, although a small number are revived, depending on what causes their heart to stop beating and how quickly medical treatment is provided. Asystole is one of the criteria that can be used to pronounce someone dead.
The heart can become asystolic for a variety of different reasons. Damage or disease to the heart can cause it to stop beating because the cells in the heart are damaged, for example, such as from drug overdoses, oxygen deprivation, and a spike in potassium levels. It is not uncommon for the heart rhythm to be irregular before the heart stops beating altogether.
On a heart monitor, an asystolic rhythm appears as a flat line, as opposed to the jagged lines associated with electrical activity in the heart. For this reason, asystolic arrest is sometimes referred to as “flatlining” in colloquial English. Fans of medical dramas may have heard this term used on television.
There are some treatments that can be used in an attempt to get the heart beating again. Drugs such as adrenaline, vasopressin and atropine may be injected, and chest compressions are used to force some blood through the circulatory system. In some cases, internal heart massage may be used, and doctors may try pacing, in which the heart is shocked with small electrical impulses in a pattern to try to restore a regular rhythm.
The main concern with asystole is that the longer the heart doesn’t beat, the more oxygen deprived the brain becomes. Even with chest compressions or CPR, not enough blood is getting to the brain. A cessation of cardiac activity for more than 15 minutes is generally considered a sign that the patient is truly dead, because even if the heart can be restarted at that point, the brain will be too badly damaged. However, every measure is taken to resuscitate the patient to the point of no return.
For the few patients who recover from asystole, it is common to experience bruising and pain in the chest, and sometimes ribs are broken with chest compressions. Follow-up care is usually needed to provide support while the patient recovers and to address the underlying condition that caused the heart to stop stopping in the first place.
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