Going away rhythm

I have seen 2 rhythm types on the natural course  of dying (peacefully). In the first, the heart rate holds for a few hours (AF or sinus) then gradually declines and the latent pacemaker kick-in one-by-one (junctional to ventricle). The other one is the one I'll post here. So this is not the sudden cardiac death (SCD) where people get excited.

These are 5 strips (~ 4 minutes duration) captured in a DNR pt. Pt was in no distress during the whole process.

Pls note timestamp on the upper left part of the strip.

Image 1 



The rhythm is regular and narrow with ST changes.The latter part of the strip shows wide QRS rhythm most likely AIVR.

Image 2 



Few seconds later, it turned into a fast wide QRS rhythm (likely VT)

Image 3



About 7 second later, change in morphology is seen (best seen in II, aVF and aVL)

Image 4


About 2 minute later, looked like the QRS voltages becomes smaller and the rate  becomes slower (agonal rhythm).

Image 5 



About 4  minutes after, asystole can be observed.


#514 

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