Asystole

Asystole will occur sooner or later to all dying patients. It is a cardiac stop with no ventricular depolarization. There are 2 types of asystole: primary and secondary.

When the system of the heart dosen’t produce a ventricular depolarization, this is when primary asystole occurs. The causes of primary asystole may be degeneration of the sinoatrial node or may be produced by ischemia. Due to complete heart block, primary asystole a bradydysrhythmia can precede a primary asystole. Reflex bradyasystole/asystole can be caused by maxillofacial surgery, ocular surgery, globe pressure, hypersensitive carotid sinus syndrome or or glossopharyngeal neuralgia.

Studies have shown that asystole and bradycardia are left temporal lobe problems caused by complex partial seizures. The patients who suffer from this show syncope or dizziness.The maximum period was 26 seconds and though no deaths occurred, this may happen if asystole is persisting.

When other factors beside the electrical conduction system of the heart are not able to produce electrical depolarization, secondary asystole takes place. Asystole or bradyasystole generally occur after unsuccessful defibrillation. Unfortunately the outcome in this situation is rather pessimistic. Among the causes that can result in secondary asystole are : near drowning, stroke, suffocation, hypothermia. Hypothermia is a special situation because it can be tolerated for long.

Scientists argue that asystole can depend on the birth place of the patient or on the country where he or she lives . For instance, when the coronary artery disease in the population of a country occurs relatively rare, asystole is more common in the form of cardiopulmonary arrests. The explanation for this situation is that cardiac ischemia more frequent in VF (ventricular fibrillation). The percent of asystole occurrence is higher in children, when they have for instance cardiopulmonary arrests. Asystole is secondary to another no cardiac event like drowning, respiratory arrest due to sudden infant death syndrome, poisoning. Children or adolescents are not so prone to cardiac arrest, but infants are. A study shows that nontraumatic cardiac arrest occurred at a rate of 72.1 in infants cases in comparison with 3.73 and 7.37 in children and adolescents.

Never minding the initial cause, asystole is associated with a bad end. Resuscitation is unlikely to have success, with the exception of the case when resuscitation is after an event that such as a cardiac arrest that can be resolved on the spot due to choking on food and the patient may be rapidly reoxygenated.

Women are more prone to suffer from this condition than in men. However cardiac arrest in general is more common in males until around 75 years of age.

The immediately diagnosis of asystole is very important. This depends of the recognition of a cardiac arrest and a confirmed flat-line rhythm in 2 perpendicular leads.

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