ASYSTOLE

DEFINITION, CAUSES
MANAGEMENT
DR SAAD GILLANI
ASYSTOLE DEFINITION

 Asystole is when there's no electricity or movement the your heart. That means
the affected person does not have a heartbeat.

 It's also known as flatline. That's because doctors check the rhythm of patients
heart with a machine called an electrocardiogram -- also called an ECG or EKG.

 It shows a straight line when there’s no heartbeat.

PATHOPHYSIOLOGY

 Asystole is when heart’s electrical system fails, causing the heart to stop pumping.

 This is also known as “flat-line” or “flat-lining” because it causes heart’s electrical

activity to look like a flat line on an electrocardiogram.

 Without immediate CPR or medical care, this condition is deadly within minutes.
ASYSTOLE
CLINICAL SYMPTOMS

 Asystole is a type of cardiac arrest, which is when heart stops beating entirely.

 This usually makes one pass out. It’s also likely that the patient will stop breathing
or that they will only have gasping breaths.

 Without immediate CPR or medical care, this condition is deadly within minutes
Why is Asystole called flat-line?

 Asystole is a clinical sign rather than a symptom because you can't see or feel it
without special equipment.
 The only way to “see” asystole is by using an electrocardiogram (often
abbreviated as ECG or EKG).
 This is a diagnostic test that involves several (usually 12) sensors attached to the
skin of your chest.
 Those sensors, called electrodes, detect your heart’s electrical activity and show it
as a wave pattern on either a printout or a screen display.
 As an electrical current travels through your heart with each heartbeat, an EKG's
waves show the strength of that current and how it moves through your heart.
There's no electrical activity to create the wave with asystole, so it appears as a
flat line.
CAUSES AND PREDISPOSING
FACTORS OF ASYSTOLE
 Asystole happens to everyone when they die.

 But some conditions raise your chances of it happening early.

 One of them is certain types of arrhythmia, or irregular heartbeat.

 A heart injury or genetics -- something that runs in your family -- could also lead
to asystole.
ELECTRICAL CONDUCTION IN THE
HEART
 How Does Your Heart Work?
 An electrical signal triggers your heart’s two upper chambers, or atria.
 This pulse travels down to the two lower chambers, or ventricles.
 It tells your atria to fill with and release blood.
 Then the ventricles pump it out.
 Normally, this happens about 60-100 times a minute. That’s your heartbeat.
ELECTRICAL SYSTEM OF THE
HEART
ELECTRICAL SYSTEM OF THE
HEART
 The heart has four chambers. The two upper chambers are called atria (the right
atrium and the left atrium), and the two lower chambers are called ventricles.

 Normally, the heartbeat starts in the right atrium in a group of special heart cells
called the sinoatrial (or sinus) node. These cells act as a pacemaker for the heart.

 The heart's pacemaker sends out an electrical signal (impulse) that spreads
throughout the heart along electrical pathways.

 These pathways transmit the signal from the upper to the lower chambers of the
heart, which causes the heart muscle to contract.
ELECTRICAL SYSTEM OF THE
HEART
 Regular, rhythmic electrical signals keep the heart pumping blood to the lungs and
the body.

 What controls the timing of your heartbeat?

 Your heart's electrical system controls the timing of your heartbeat by regulating
your:

 Heart rate, which is the number of times your heart beats per minute.
 Heart rhythm, which is the synchronized pumping action of your four heart
chambers.
What makes your heart rate speed up or
slow down?
 The cells of the SA node at the top of the heart are known as the pacemaker of the
heart because the rate at which these cells send out electrical signals determines
the rate at which the entire heart beats (heart rate).

 The normal heart rate for an adult at rest ranges between about 60 and 100 beats
per minute. Your heart rate can adjust higher or lower to meet your body's needs.
What makes your heart rate speed up or
slow down?
 Your brain and other parts of your body send signals to stimulate your heart to
beat either at a faster or a slower rate.
 Although the way all of the chemical signals interact to affect your heart rate is
complex, the net result is that these signals tell the SA node to fire charges at
either a faster or slower pace, resulting in a faster or a slower heart rate.

 For example, during periods of exercise, when the body requires more oxygen to
function, signals from your body cause your heart rate to increase significantly to
deliver more blood (and therefore more oxygen) to the body. Your heart rate can
increase beyond 100 beats per minute to meet your body's increased needs during
physical exertion.
What makes your heart rate speed up or
slow down?
 Similarly, during periods of rest or sleep, when the body needs less oxygen, the
heart rate decreases.

 Some athletes actually may have normal heart rates well below 60 because their
hearts are very efficient and don't need to beat as fast.

 Changes in your heart rate, therefore, are a normal part of your heart's effort to
meet the needs of your body.
NORMAL PARAMETERS

 Your heart's electrical system should maintain:

 A steady heart rate of about 60 to 100 beats per minute at rest.

 The heart's electrical system also increases this rate to meet your body's needs
during physical activity and lowers it during sleep.
 An orderly contraction of your atria and ventricles (this is called a sinus rhythm).
MECHANISM OF ASYSTOLE

 What Causes Asystole?

 Asystole is caused by a glitch in your heart’s electrical system.
 You can get a ventricular arrhythmia when the signals are off.
 That’s when your lower chambers don’t beat the right way. So your heart can’t
pump blood to the rest of your body.
 This is cardiac arrest. Ventricular arrhythmias that may lead to asystole are:
How does asystole work?

 Every time your heart beats, it does so in two steps: systole (sis-toe-lee) and
diastole (dye-ast-oh-lee).

 Systole: Each heartbeat happens because your heart generates a small electrical
current, which then moves through your heart. That current is necessary because
as it travels, it triggers a squeezing action — systole — in each section of heart
muscle.
 Diastole: This is when your heart muscle relaxes between beats. The relaxed
muscle lets your heart’s chambers expand and fill up with blood, and your heart
will pump out that blood during the next heartbeat.
How does Asystole work?

 When asystole happens, your heart’s electrical system has no detectable activity at
all.
 Without electrical current, your heart stops pumping entirely, and you go into
cardiac arrest.
 When you go into cardiac arrest, this is a state known as “clinical death.”
ASYSTOLE VS PULSELESS
ELECTRICAL ACTIVITY : WHATS
THE DIFFERENCE ?
 Pulseless electrical activity and asystole are both ways that cardiac arrest happens.

 Pulseless electrical activity means that your heart still has electrical activity, but it
isn’t strong or organized enough to make your heart pump.
 On an electrocardiogram, PEA forms wave patterns, some of which look very
similar to normal heart rhythms. That means your heart’s electrical system is still
working, but it’s too weak or disorganized, and you don’t have a pulse with it.
With asystole, you have no pulse and no electrical activity.
MOST COMMON CAUSES OF
ASYSTOLE
 Asystole can happen because of any health condition or event that causes cardiac
arrest or significantly disrupts your heart’s electrical system. Some of the most
common causes of asystole include:

 Blood loss.
 Low oxygen levels.
 Electrolyte problems or dehydration.
 Heart attack.
MOST COMMON CAUSES OF
ASYSTOLE
 Pulmonary embolism.
 Irregular heart rhythms (arrhythmias), especially ventricular fibrillation and
ventricular tachycardia.
 Trauma (either directly to the heart or to the chest overall).
 Electrocution.
 Toxins, especially certain types of prescription medications or recreational drugs
(such as cocaine).
MOST COMMON CAUSES OF
ASYSTOLE
 Ventricular fibrillation. With VFib, the lower chambers tremble, or fibrillate,
instead of contracting normally. If it’s not treated within a few minutes, you can
die. Your chances of VFib are higher if you:

 Have a weak heart muscle (cardiomyopathy)

 Have already had a heart attack
 Have heart disease
 Are born with certain genetic diseases (long or short QT syndrome, Brugada
syndrome)
MOST COMMON CAUSES OF
ASYSTOLE
 Take medications that affect your heart
 Have an electrolyte imbalance
 Have drug poisoning
 Have a serious infection (sepsis)
MOST COMMON CAUSES OF
ASYSTOLE
 Pulseless ventricular tachycardia. Your heart will beat so fast, it can’t pump blood.
V-tach can be life-threatening if it lasts for more than a few seconds. It may turn
into VFib. Your chances of V-tach are higher if you:

 Have a weak heart muscle (cardiomyopathy)

 Have had a heart attack before
 Use illegal drugs, like cocaine
 Take certain medications
 Have sarcoidosis (an inflammatory disease)
MOST COMMON CAUSES OF
ASYSTOLE
 Pulseless electrical activity (PEA). This is when you have electricity in your heart,
but it doesn’t pump normally. It can turn into asystole if not treated right away.

 Other conditions that may lead to asystole include:

 Hypoxia: Low oxygen

 Hypovolemia: Low levels of blood in your body
 Hypo/hyperkalemia: Too little or too much potassium
 Hypothermia: Body temperature that’s too low
MOST COMMON CAUSES OF
ASYSTOLE
 Hydrogen ion (acidosis): Too much acid in the body
 Tension pneumothorax: Air pressure buildup around your lungs
 Tamponade: Blood or fluid buildup around your heart
 Toxins: Poisons in your body
 Thrombosis:Blood clots in your heart or lungs
TREATMENT OF ASYSTOLE

 Can You Reverse Asystole?

 In the movies, they sometimes shock a flatlined heart with a defibrillator. That’s a
machine that uses an electric pulse to get your heartbeat back to normal. But it
doesn’t usually help in real life. Typically, less than 2% of people survive
asystole. Your odds depend on what causes your heart to stop. If you can be
treated, a doctor or paramedic may give you:
TREATMENT OF ASYSTOLE

 Cardiopulmonary resuscitation (CPR). High-quality CPR acts like a heartbeat.

This can keep blood flowing through your body.
 Epinephrine. Also called adrenaline, this drug can boost blood flow. Some experts
think more research is needed on its role in cardiac arrest.
TREATMENT OF ASYSTOLE

 When to Do in an Emergency
 Someone in cardiac arrest might:

 Not respond
 Have trouble breathing
 Not breathe at all
 Call 911 right away if you think someone is in cardiac arrest. If you know how,
give them hands-only CPR until emergency workers arrive. It’s a good idea to
wear a medical ID bracelet if you have a heart problem.
TREATMENT OF ASYSTOLE

 Care and Treatment

 How is this problem treated?
 Asystole is part of cardiac arrest, which is a medical emergency where every
second counts. While it’s only possible to confirm asystole with an EKG, the
treatment for cardiac arrest is the same no matter what the cause.

 When cardiac arrest happens outside of a hospital, the most important thing is to
immediately start CPR and continue it until emergency medical personnel arrive.
Effective, continuous CPR offers the best chance of survival.
TREATMENT OF ASYSTOLE

 Inside a hospital, the following treatments are possible:

 CPR. Medical professionals will immediately start this when a person goes into
cardiac arrest.
 Epinephrine. This medication, also known as adrenaline, can help restart your
heart.
 Treating the underlying problem. When asystole happens because of an
underlying problem, such as an electrolyte imbalance or hypothermia, treating
that problem is key. In many cases, remedying that underlying problem will help
restart the heart and return it to a normal rhythm.
TREATMENT OF ASYSTOLE

 Is asystole a “shockable” rhythm?

 Defibrillation is an emergency treatment that involves an intense electrical shock
to your chest. It's used to "convert" an abnormal heart rhythm into a normal one.
Defibrillation outside a hospital setting is possible using devices called
Automated External Defibrillators (AEDs). These devices can detect heart
rhythms and deliver a shock if needed.

 However, the only “shockable” heart rhythms are ventricular fibrillation and
pulseless ventricular tachycardia. Asystole isn't a shockable rhythm, and
defibrillation may actually make it harder to restart the heart. Defibrillation is
only an option if your heart goes from asystole to a shockable rhythm, which is
possible when someone with asystole receives effective CPR.
TREATMENT OF ASYSTOLE

 When to Call the Doctor

 When should this symptom be treated by a doctor or healthcare provider?
 Asystole, like any form of cardiac arrest, is a medical emergency that needs
immediate medical care. If someone near you has the following:

 Fainting or passing out.

 Gasping for breath or not breathing at all.
 No pulse in their neck or wrist.
TREATMENT OF ASYSTOLE

 Call 911 (or the appropriate number for your local emergency medical services)
and start CPR right away. Immediate, effective, and continuous CPR is critical to
saving a person’s life when they are having a cardiac arrest.

 If you don't know CPR, calling 911 immediately is still important. That's because
911 dispatchers can give you CPR instructions over the phone, which means you
can make a difference and possibly save someone’s life if you don’t know CPR.
TREATMENT OF ASYSTOLE

 A note from Cleveland Clinic

 Asystole is a dangerous problem that happens with cardiac arrest. Without quick
action and CPR, the odds of survival are very low. However, the odds of survival
are much higher when a person in cardiac arrest receives CPR quickly and
effectively. Knowing how to do CPR and being prepared are critical, and the
faster a person with asystole gets medical care, the more likely that they’ll have a
good outcome.