Agonal rhythm is an abnormally slow heart rhythm that occurs near the end of life. It can be difficult thinking about the death of a loved one. But learning more about what happens in the final moments of life might make their passing a little less painful.
An agonal rhythm is an abnormally slow, erratic rhythm originating from your heart’s lower chambers (ventricles). This type of severe arrhythmia occurs after your heart’s upper chambers have stopped working.
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During an agonal heart rhythm, your heart isn’t pumping blood out to the rest of your body, and your organs aren’t receiving oxygen. This form of arrhythmia is the last type of heart rhythm that occurs before asystole. In asystole, all electrical activity in the heart stops and a person dies.
Agonal means: “of, relating to, or associated with the act of dying: occurring just before death.” There are several medical conditions associated with death that contain the word agonal, such as agonal breathing or respiration, the agonal state (state of the body just prior to death) and agonal rhythm.
The name of this condition stems from the same root word as the word “agony.” When a person is experiencing agonal rhythm, they may make movements and noises that appear as if they are in agony. But they aren’t likely to experience any pain or discomfort. Because the brain starts shutting down due to lack of oxygen, the person loses consciousness and isn’t able to feel pain.
A person with a heart rate of less than 20 beats per minute likely has an agonal rhythm. An electrocardiogram (EKG) helps confirm it.
Signs of an agonal rhythm on an EKG readout include:
Symptoms of an agonal heart rhythm include:
Severe injury to the heart muscles causes an agonal heart rhythm. They can include:
Additional conditions that can lead to cardiac arrest include:
Agonal rhythm is not the same thing as agonal breathing. But a person may experience both of them during a cardiac event. Agonal breathing is a near-death condition where a person gasps and moans. Their face may grimace as if they’re in pain. But, like with agonal rhythm, a person experiencing agonal breathing isn’t in agony. Most likely, they’re unconscious and what you see is only a reflex.
An agonal heart rhythm is not a condition you can avoid. It happens as the result of cardiac trauma or some other medical emergency causing cardiac arrest.
Even if your loved one is unconscious, you can still comfort them. As their body shuts down, they’ll likely maintain some sense of touch and the ability to hear.
You can comfort them simply by being there. Hold their hand and talk to them. Tell them you love them.
A note from Cleveland Clinic
Agonal rhythm occurs shortly before death. A person experiencing agonal rhythm is no longer conscious, but reflexes in the brainstem are trying to keep them alive. Unfortunately, once a person’s heart is in an agonal rhythm, death is imminent. But you can still comfort your loved one with kind words and loving touch.
Last reviewed by a Cleveland Clinic medical professional on 04/30/2022.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy