Asystole?

Does anyone know of a pacemaker setting or complication that would make hospital heart monitors think you are in asystole when you are not? I ended up in the hospital after another (!) fainting spell and the alarm would not stop going off. It kept saying I was in asystole. This is not the first time that's happened in various ERs so I was wondering if maybe there's something with my PM that is interfering with the monitoring. I'm pretty sure I wasn't actually in asystole.

6 Comments

Another term for asystole

by ElectricFrank - 2011-08-29 02:08:03

I would question the monitor except for your having a fainting spell at the same time. The two together make a pretty good case that your heart stopped. This can happen where your heart skips several beats in a row. I had a situation where I was skipping 4-5 beats and then restarting. While this wasn't long enough to cause me to pass out or experience light headedness, it set the alarms off. If it had extended out to 10 seconds or so the outcome would have been different

One problem with trying to figure this out is that as your time in asystole becomes longer and your brain is going without oxygen you start to lose the ability to know what is happening.

By the way most hospitals record the monitor waveforms and can be printed out later. You might ask to see them and the warning times explained.

frank

Pacemaker and Asystole

by SMITTY - 2011-08-29 04:08:45

Hi Jenny,

From what little I know about asystole it is one of the most complex problems we run into with heart disease. As Frank said passing out is a classic symptom of asystole, but passing out does not always mean the presence of asystole. Also, I can think of no reason a PM would cause a person on a monitor to be shown as being flatlined.

You brought up a subject that I experienced in July 2000, I remember the time well. Although I have not given the reason for what went on I have often thought back to that time. I recall being in the hospital for 5 or 6 days while the Drs had fun trying to pin down what was causing my occasional flatline. The flatline never lasted more than a few seconds, but long enough for the nurses to show up at my bedside one time all ready to jump start my heart. Fortunately that was never done. It turned out some of my flatlines, but not all, were the result of a poor electrode connection. I don't know how many doctors did not pick that up and a nurse that had been off duty for a few days came in solved that problem immediately. She had seen it before from that bed and knew what to look for. Anyway I went home with the promise I needed a defibrillator.

I was sent to an EP and he said no defibrillator, but I needed a pacemaker. I guess the PM helped because the asystole stopped. My opinion is it stopped the asystole because the EP set my low set point at 80, where my natural heart rate had been 60, give or take a few beats. What that did, I think, was have my heart beating so fast the ventricle couldn't hesitate long enough to go into asystole, or whatever. It must have worked because the asystole stopped and after a few months I got the PM reset to a low of 70 because the 80 was uncomfortable, especially when trying to sleep.

Now back to the Drs reason I got a PM. The plan was in case I had an episode of asystole the PM would step in and do what you asked about yours doing, keep my heart beating. But it is not always so simple. But let me back up a minute.

Bear with me here (if I insult your intelligence here, please forgive me) as I go through the whys, the hows and wherefores a PM is supposed to help us anytime.

As you know our heart has a natural pacemaker, located in the upper chamber of the heart, that generates and sends an electrical impulse first to the atrial to make it contract to move blood it is holding to the ventricle. That electrical impulse hesitates for a few tenths of a millisecond after making the atrial contract and then travels on to the ventricle where it makes it contract and pump blood out to the far reaches of our body. For reasons I don't understand the ventricle will not always respond to that impulse as it should and instead of contracting it sits there and starts to beat so fast is like, for like of a better description, vibrating. Ordinarily we think our new PM should notice the ventricle is not beating as it should and send an impulse to make the ventricle contract. But the problem is the new PM checks to see if the heart's PM is sending an impulse before it will send one. It therefore sits and waits and does not send an impulse because the heart's natural PM has sent one and that is when asystole can occur. But the new PM is constantly on the job and if in a second or two the heart's natural PM doesn't send an impulse the new PM will step in and send one and maybe, and I don't know, a stronger impulse, or for what ever reason, it will make it to the ventricle and get it going with a natural rhythm. In the meantime, if you are on a monitor it may well show you as having flatlined for a few seconds. As I recall, although I did not at the time have a PM the longest period I flatlined was 6 seconds.

My guess is if a person has a defibrillator and such episode occurs it would send an electrical shock to completely stop the ventricle in order to take it out of the vibrating mode with the intent the heart would restart itself in normal rhythm. I know there must be a reason people do not automatically get defibrillators when they are having asystole, but I do not have a hint there.

Anyway that is was I can recall from my stay in the hospital and what I have learned since about why I now have PM and not defibrillator.

Good luck to you,

Smitty

PM's Purpose?

by jenny97 - 2011-08-29 09:08:03

Isn't that what the PM is supposed to avoid? I mean, I have heart block and vasovagal/neurocardiogenic syncope and the PM was implanted for the both of those. How can you go into asystole with a perfectly functioning PM in place?

And thanks....

by jenny97 - 2011-08-29 09:08:04

Sorry, I meant to say thank you for your input at the outset. I always appreciate your comments and have learned a lot from your posts...I'll check with the hospital to see if I can get records. In the meantime, i am just trying to survive until I make it to my appointment at Mayo in November.

Pacemaker and asystole

by ElectricFrank - 2011-08-30 01:08:26

It is quite possible to have a pacemaker and still experience asystole. All the pacer can do is tickle the heart with a maximum of about 7 volt jolt which may not be enough to get it to respond. That is what the ICD is for. It can deliver a 700 volt message and even with with that it is possible for the heart not to respond. The next step is the paddles followed by the undertaker.

It's obvious you are nowhere near that as yet, but I shows that a pacer may not be able to prevent asystole.

frank

Thanks, Smitty and Frank!

by jenny97 - 2011-08-30 12:08:26

You guys are great! Thanks for sharing your knowledge and experiences. No one at the hospital seemed all that concerned at the recurring asystole alarms and eventually turned the heart monitor off entirely (!) I was grateful, though, because the alarm was driving me nuts. And I was already beat from the syncope, the fall, and all the excitement and trauma of another "emergency," paramedics and all.

Can I just say, though, on an almost completely unrelated side note, how grateful I am to live in a place where someone stops when they see another person lying unconscious on the sidewalk? I have a friend in another country who passed out while pregnant, and holding the hand of her 2 year old. No one stopped to help them.

And finally, if it was real asystole, will it show up on the PM interrogation? And if asystole was the cause of the syncope, will it show?

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