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  Asystole

Asystole is a disorder of impulse transmission which is described as a state of no cardiac electrical activity. Therefore, there is no impulse transmission and no contractions of the myocardium or the heart muscles. Since there are no heart contractions, it follows that there are also no cardiac output or blood flow. In short, asystole is one of the conditions required for a doctor in certifying death which is verified by getting an electrocardiogram tracing.

Asystole
Asystole


In asystole cases, the heart is not likely to respond to defibrillation because it is already in a depolarized state, however, some emergency doctors still advocate a trial of defibrillation especially when the rhythm is found out to be having fine ventricular fibrillation, or other rhythms that are still shockable but too small to be visualized on the monitor. Nevertheless, there is still hope for asystole cases once confirmed by a physician; there are still effective treatments available. Once diagnosed with asystole, prognosis is not good because this is often the last stage of heart disease and the only possible way to make an asystolic heart to beat again is by emergency administration of the life saving drug popularly known as Epi or epinephrine also called adrenaline. Other appropriate treatments for asystole is using atropine (an anti-arrhythmic drug), which works by blocking the vagal tone that may be preventing the heart from beating, and finally, the last resort is to pace the heart, or applying a small electric shock to the heart at a regular rate in the hope of causing it to beat again.

It is also important to perform a cardiopulmonary resuscitation (CPR) while the heart is in asystole, because there will be no cerebral blood flow or blood flow to the brain while the heart is not contracting. Others may do internal cardiac massage, wherein the chest is opened via thoracotomy and the heart is compressed manually warranted in this case to save the life of the patient. After many emergency treatments have exhausted but to no avail, and the heart is still not responsive, this is now the time to consider pronouncing the patient dead as evidenced with electrocardiogram record. In rare cases, even if a rhythm should reappear, but if the state of asystole has already persisted for longer than fifteen minutes, the brain will have been deprived of oxygen long enough to cause brain death. This is due to the fact that the brain is very dependent on its blood supply specifically the Circle of Willis located at the base of the brain. The brain is receiving approximately 2% of the body’s blood volume. The cerebral vessels are the main source of oxygen and glucose (sugar) of the brain. Thus, any impairment to cerebral blood flow just like in asystole or cardiac arrest for more than 15 minutes, death of the brain cells known as neurons (the basic functional unit of the nervous system) is already very significant. As a matter of fact, even if the patient is revived successfully after life saving emergency treatments such as giving epinephrine intravenously (IV) along with cardiopulmonary resuscitation (CPR), irreversible brain (neurologic) damage may still happen which is already permanent.

It is essential to determine the underlying cardiac pathology to prevention of occurrence of asystole. Cardiac life threatening arrhythmias are particularly important to control and managed appropriately such as the following: atrial flutter, atrial fibrillation (Acute or Chronic Afib), Wolff-Parkinson-White syndrome, supraventricular tachycardia (SVT) or Vtach, ventricular flutter and ventricular fibrillation etc. Proper management to convert the abnormal rhythm back to the normal sinus rhythm is necessary to reduce the rate of morbidity and mortality.

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