心室無収縮、不全収縮

WordNet

of or relating to a ventricle (of the heart or brain)
absence of systole; failure of the ventricles of the heart to contract (usually caused by ventricular fibrillation) with consequent absence of the heart beat leading to oxygen lack and eventually to death (同)cardiac_arrest, cardiopulmonary_arrest

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/01/07 13:34:06」(JST)

wiki en

In medicine, asystole /əˈsɪstəliː/, colloquially known as flatline, is a state of no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow. Asystole is one of the conditions that may be used for a medical practitioner to certify clinical or legal death.

Asystole is treated by cardiopulmonary resuscitation (CPR) combined with an intravenous vasopressor such as epinephrine (adrenaline). Sometimes an underlying reversible cause can be detected and treated (the so-called 'H's and T's', an example of which is hypokalaemia). Several interventions previously recommended—such as defibrillation (known to be ineffective on asystole, but previously performed in case the rhythm is actually fine ventricular fibrillation) and intravenous atropine—are no longer part of the routine protocols recommended by most major international bodies.^[1] Asystole may be treated with 1 mg epinephrine by IV every 3-5 minutes as needed. Vasopressin 40 units by IV every 3-5 minutes may be used in place of the first and/or second doses of epinephrine, but doing so does not enhance outcomes.

Survival rates in a cardiac arrest patient with asystole are much lower than a patient with a rhythm amenable to defibrillation; asystole is itself not a "shockable" rhythm. Out-of-hospital survival rates (even with emergency intervention) are less than 2 percent.^[2]

Cause

Possible underlying causes include the Hs and Ts.^[3]^[4]^[5]

Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
Hypothermia
Hyperkalemia or Hypokalemia
Hypoglycemia
Tablets or Toxins (drug overdose)
Cardiac Tamponade
Tension pneumothorax
Thrombosis (myocardial infarction or pulmonary embolism)
Trauma (hypovolemia from blood loss)

While the heart is asystolic, there is no blood flow to the brain unless CPR or internal cardiac massage (when the chest is opened and the heart is manually compressed) is performed, and even then it is a small amount. After many emergency treatments have been applied but the heart is still unresponsive, it is time to consider pronouncing the patient dead. Even in the rare case that a rhythm reappears, if asystole has persisted for fifteen minutes or more, the brain will have been deprived of oxygen long enough to cause brain death.

ECG lead showing asystole (flatline)

References

^ AHA Cardiac Recussitation Guidelines, 2010: http://circ.ahajournals.org/cgi/content/full/122/18_suppl_3/S729
^ http://journals.lww.com/surveyanesthesiology/Citation/2008/10000/Medical_Futility_in_Asystolic_Out_of_Hospital.44.aspx
^ Mazur G (2004). ACLS: Principles And Practice. Dallas: American Heart Assn. pp. 71–87. ISBN 0-87493-341-2.
^ Barnes TG, Cummins RO, Field J, Hazinski MF (2003). ACLS for experienced providers. Dallas: American Heart Assn. pp. 3–5. ISBN 0-87493-424-9.
^ ECC Committee, Subcommittees and Task Forces of the American Heart Association (Dec 2005). "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 7.2: Management of Cardiac Arrest.". Circulation 112 (24 Suppl): IV1–203 (7.2 IV58–66). doi:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375.

UpToDate Contents

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1. 成人における二次救命処置（ACLS） advanced cardiac life support acls in adults
2. 成人における突然の心停止後の予後および転帰 prognosis and outcomes following sudden cardiac arrest in adults
3. 心筋梗塞時および心筋梗塞後の心室性不整脈予防 prophylaxis against ventricular arrhythmias during and after acute myocardial infarction
4. 突然の心停止を呈した成人に対する二次救命処置を支持するデータ supportive data for advanced cardiac life support in adults with sudden cardiac arrest
5. 急性心筋梗塞患者の心室性不整脈の臨床的特徴および治療 clinical features and treatment of ventricular arrhythmias during acute myocardial infarction

English Journal

Optimal blood pressure for favorable neurological outcome in adult patients following in-hospital cardiac arrest.

Wang CH1, Huang CH2, Chang WT2, Tsai MS2, Yu PH3, Wang AY2, Chen NC4, Chen WJ5.
International journal of cardiology.Int J Cardiol.2015 Sep 15;195:66-72. doi: 10.1016/j.ijcard.2015.05.131. Epub 2015 May 22.
BACKGROUND: Adequate cerebral blood flow maintained by optimal blood pressure is important in neurological recovery for patients sustaining transient brain ischemia. Few clinical studies have investigated the relationship between blood pressure and neurological outcomes of patients resuscitated foll
PMID 26025859

Therapeutic hypothermia in patients with out-of-hospital arrest.

Maznyczka AM1, Gershlick AH2.
Heart (British Cardiac Society).Heart.2015 Aug 15;101(16):1265-71. doi: 10.1136/heartjnl-2014-307411. Epub 2015 May 2.
Therapeutic hypothermia (TH) is increasingly used in patients presenting with out-of-hospital cardiac arrest (OHCA). Such strategies derive from data that suggest TH may improve survival and attenuate adverse neurological outcomes associated with the cardiac arrest. Consequently, TH has been integra
PMID 25935766

Impact of Heart Disease on Maternal and Fetal Outcomes in Pregnant Women.

Koutrolou-Sotiropoulou P1, Parikh PB1, Miller C1, Lima FV1, Butler J1, Stergiopoulos K2.
The American journal of cardiology.Am J Cardiol.2015 Aug 1;116(3):474-80. doi: 10.1016/j.amjcard.2015.04.063. Epub 2015 May 9.
Pregnant women with underlying heart disease (HD) are at increased risk for adverse maternal and fetal outcomes. In this study, we sought to identify the risk and risk factors for adverse maternal and fetal events in pregnant women with underlying HD. Pregnant women referred for echocardiogram with
PMID 26059869

Japanese Journal

Neurological outcomes in children dead on hospital arrival

Critical Care 19(1), 410, 2015-11-18
NAID 120005680032

Identification of High-Risk Brugada Syndrome Patients by Combined Analysis of Late Potential and T-Wave Amplitude Variability on Ambulatory Electrocardiograms

Circulation journal : official journal of the Japanese Circulation Society 77(3), 610-618, 2013-02-25
NAID 10031138948

剖検により全身性炎症の合併が判明した心臓突然死の一例

山形大学紀要. 医学 : 山形医学 30(1), 23-31, 2012-02-25
NAID 110008906961

Related Pictures

★リンクテーブル★

リンク元	「不全収縮」「心室無収縮」
関連記事	「ventricular」

「不全収縮」

Asystole
	Classification and external resources
	A rhythm strip showing a couple beats of sinus rhythm followed by an atrial beat and asystole.
ICD-10	I46.0
ICD-9	427.5

　　[★]

英: ventricular asystole
関: 心室無収縮

「心室無収縮」

　　[★]

英: ventricular asystole
関: 不全収縮

「ventricular」

　　[★]

adj.

室の、心室の、脳室の、心室性の

関: cardiac ventricle、cerebral ventricle、cerebroventricle、cerebroventricular、heart ventricle、ventricle、ventriculi、ventriculus

[1] AHA Cardiac Recussitation Guidelines, 2010: http://circ.ahajournals.org/cgi/content/full/122/18_suppl_3/S729

[2] ttp://journals.lww.com/surveyanesthesiology/Citation/2008/10000/Medical_Futility_in_Asystolic_Out_of_Hospital.44.aspx

[ACLS_2003_H_T-3] Mazur G (2004). ACLS: Principles And Practice. Dallas: American Heart Assn. pp. 71–87. ISBN 0-87493-341-2.

[ACLS_2003_EP_HT-4] Barnes TG, Cummins RO, Field J, Hazinski MF (2003). ACLS for experienced providers. Dallas: American Heart Assn. pp. 3–5. ISBN 0-87493-424-9.

[ECC_2005_7.2-5] ECC Committee, Subcommittees and Task Forces of the American Heart Association (Dec 2005). "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care - Part 7.2: Management of Cardiac Arrest.". Circulation 112 (24 Suppl): IV1–203 (7.2 IV58–66). doi:10.1161/CIRCULATIONAHA.105.166550. PMID 16314375.

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案内

案内

ventricular asystole