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The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Agonal Rhythm on ECG
Introduction
Agonal rhythm is a medical emergency commonly seen in cases of severe heart dysfunction, particularly in situations leading to cardiac arrest. It is an extremely slow and irregular rhythm that suggests the heart is barely generating any effective electrical activity.
Definition
Agonal rhythm is a severe form of bradyarrhythmia (abnormally slow heart rhythm) where the heart rate is usually below 20 beats per minute. It often represents the last organized electrical activity before asystole (complete absence of heart electrical activity).
ECG Characteristics
- Rate: Extremely slow (often < 20 bpm)
- Rhythm: Irregular and disorganized
- P Waves: Usually absent or dissociated from QRS complexes
- QRS Complexes: Wide and bizarre due to ineffective conduction
- Transition to Asystole: Often a precursor to complete cardiac electrical standstill
Clinical Significance
Agonal rhythm typically occurs in cases of: 1. End-stage cardiac arrest - When resuscitation efforts are failing 2. Severe hypoxia or ischemia - Due to lack of oxygen supply to the heart 3. Severe electrolyte imbalances, drug toxicity, or metabolic disturbances 4. Massive myocardial infarction (heart attack)
Emergency Management
- Immediate Cardiopulmonary Resuscitation (CPR)
- Advanced Cardiac Life Support (ACLS) Protocols
- Assessment for Reversible Causes (H’s and T’s):
- Hypoxia, Hypovolemia, Hydrogen ion (acidosis), Hypo-/Hyperkalemia, Hypothermia
- Tension pneumothorax, Tamponade (cardiac), Toxins, Thrombosis (pulmonary or coronary)
- Epinephrine and Vasopressor Support
- Definitive Treatment - If reversible causes are identified
Conclusion
Agonal rhythm is a critical medical condition that requires immediate intervention. Recognizing it on an ECG is vital for initiating life-saving measures.
Source recommendations
1. American Heart Association Guidelines on Advanced Cardiac Life Support (ACLS)
- https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000001194
- https://cpr.heart.org/en/cpr-courses-and-kits/healthcare-professional/acls
- https://www.ahajournals.org/doi/10.1161/CIR.0000000000000916
- https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/adult-basic-and-advanced-life-support
2. European Resuscitation Council Guidelines on Cardiac Arrest Management
- https://www.sciencedirect.com/science/article/pii/S0300957221000642
- https://link.springer.com/article/10.1007/s00134-021-06368-4
- https://cprguidelines.eu/
- https://www.resuscitationjournal.com/article/S0300-9572(21)00064-2/fulltext
- https://cprguidelines.eu/guidelines-2021
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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