The flat electrocardiogram--systole or asystole?

A case of stone heart syndrome is reported in a pregnant 27 year old West African patient, who suffered syncopal symptoms shortly before cardiac arrest. The electrocardiographic features were those of asystole, but direct examination of the heart at emergency thoracotomy in the A&E department revealed tetanic contracture of the organ. At necropsy, the heart was of normal weight but showed areas of fibrosis surrounding the bundle of His. The discrepancy between the ECG features and the physiological state of the heart raises the possibility that other cases of apparent asystole may not be what they seem.