The last beat of the heart: Let's talk about Agonal Rhythm (Agonal Rhythm)

You may not have heard this term before. But it is something we all hear at some point, especially when a loved one is nearing the end of their life. Agonal Rhythm is a very sensitive and serious condition. It is normal to feel scared and shocked when you hear this term. That is why it is so important to be fully aware of it. Let's talk about it simply, in a way that makes sense, as if we were talking to a close friend.

What is Agonal Rhythm simply?

Simply put, an agonal rhythm is the last, irregular heartbeat that occurs in a person's heart just before death. It is a very slow, abnormal heartbeat.

Think of our heart as a small house with four chambers. There are two chambers on top (atria) and two chambers on the bottom (ventricles). Normally, the lower chambers contract in response to an electrical signal from the upper chambers and pump blood throughout the body. This is our normal heartbeat.

But in the case of Agonal Rhythm, the upper chambers of the heart, the atria, stop working completely. They don't send any electrical signals. Then the lower chambers of the heart, the ventricles, start beating as they can, without any connection, very slowly, as a last-ditch effort. This is like a torch that suddenly goes out with a barely charged battery, without mains power. We consider this a severe heart rhythm disorder (arrhythmia).

Can someone in this condition survive?

This is a difficult question to ask, but it's important to know the truth. Someone with an agonal rhythm is not really capable of living.

The reason for this is, as I said before, this irregular, weak pulse does not pump enough blood to the body. The brain, the kidneys, the lungs, nowhere gets oxygen. This is the last heartbeat pattern that occurs before a state called `asystole` (in our colloquial language, `flat line`), when all electrical activity in the heart stops. `Asystole` is a medically confirmed case of death.

What does the word 'agonal' mean? Does it really feel like pain?

The word "agonal" comes from a root related to the word "agony." It means "pain of death" or "pertaining to the process of dying." So when we hear this name, we might think that this is a condition that causes unbearable pain.

But there is something very important that we all need to understand here.

A person with an agonal rhythm does not feel any pain or discomfort. During this time, the person may make some movements and make sounds like groans. To an outside observer, it may appear that the person is in pain. But that is not the real situation.

The reason for this is that as soon as the oxygen supply to the brain stops, the brain stops functioning. Therefore , the person becomes unconscious. An unconscious person cannot feel pain. The things we see, such as moaning and twitching, are just reflexes that occur automatically in the brainstem. It is like the leg of an unconscious person twitching when you tap it on the leg.

What are the characteristics of an agonal rhythm?

This condition is diagnosed by doctors. It is usually suspected when the heart rate drops below 20 beats per minute. This can only be confirmed with an `electrocardiogram`, or `EKG` test.

What causes this situation?

Agonal Rhythm is not a disease that occurs on its own. It is caused by very serious damage to the heart or another medical emergency that leads to cardiac arrest.

The main possible reasons are:

• Serious damage to the heart itself:
• Cardiac tamponade: The thin membrane surrounding the heart fills with blood or fluid, pressing on the heart.
• Cardiac trauma: A serious injury to the chest, such as a stab wound, a gunshot wound, or a fall from a great height.
• Ventricular fibrillation: This is when the lower chambers (cells) of the heart start beating uncontrollably. This is also an immediate cause of heart attack.

• Other emergencies that can lead to a heart attack:
• Carbon monoxide poisoning: Inhaling smoke prevents oxygen from reaching the blood.
• Drowning in water.
• Drug overdose.
• Electric shock.
• Severe seizure (`Seizure`).
• Excessive bleeding (`Hemorrhage`).
• Choking or strangulation.
• Stroke.
• Serious head injuries (Traumatic brain injury - TBI).

Are Agonal Rhythm and Agonal Breathing the same thing?

Many people confuse these two. But these two are two different things.

• Agonal Rhythm: This is related to the electrical activity of the heart . That is, the pattern of the heart beating.
• Agonal Breathing: This is related to the breathing process . It is when a person appears to be gasping for breath, gasping for air. This is also a reflex action from the brain stem near death, and is not an actual attempt to breathe.

But both of these conditions can occur at the same time in a person. The important thing is that in both Agonal Breathing and Agonal Rhythm, the person is not conscious and therefore does not feel any pain or distress.

How can we comfort our loved one at a time like this?

This is the most important and sensitive part of this topic. It's very difficult to bear seeing someone you love in this situation. But even then, there are things you can do to comfort that person.

Doctors say that when all other senses in a person's body are shut down, hearing and touch are the last two senses to be lost. This means that even if they are unconscious, the person may still be able to sense what you say and your touch to some extent.

• Hold that person's hand. Your touch can be a great comfort to that person.
• Speak calmly and lovingly. Say what's on your mind. Say things like, "I love you," "You're not alone, I'm here."
• Say something pleasant to the person. Chant a few Pirith chants, recite a religious verse, or hum a song that the person would like to hear.

Agonal Rhythm is a sign that death is very close. It is a state that cannot be reversed. But when your loved one takes that last journey, your loving words and touch will comfort that person. And, you will also be left with the comfort of knowing, "I did not leave him alone, I was there until the last moment."

Agonal Rhythm, cardiac arrest, heart rate, death, final moments, asystole, heart attack, cardiac arrest