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Electrocardiograms are non-invasive devices that allow doctors to monitor a patient's heart rhythm, and are the best way for doctors to detect irregularities with the heart early enough to do something about them. Electrocardiograms are also Hollywood's favorite way of telling the audience that a hospital patient is in the process of dying.
You've Seen It a Million Times. An injured or sickly character will go into the hospital, and while there will be hooked up to a machine that goes PING!. As long as the electrocardiogram machine is beeping, and as long as the line on the screen that indicates the character's heart is still beating is going up and down like a metronome, everything's fine. But then suddenly, the beeping becomes erratic and the lines on the screen will start jumping up and down until finally, the lines flatten out and the machine lets out one long sustained beep! The medical personnel scramble about, someone in the background is calling a Code Blue over the intercom, and inevitably a defibrillator will be wheeled in. Sometimes, the character will be revived and the beeping and regular jagged lines on the machine's screen restart.
And sometimes not.
The technical term for a "flatline" is asystole ("a-" for lacking, "systole" for the contraction cycle of a heartbeat). This event is not always the result of the character having a heart condition; asystole can be caused by lots of things, including profound hypoxia (lack of oxygen in the blood), poisonings and intoxications, and consequences of trauma (i.e. massive hemorrhage, tension pneumothorax - leaking air from a collapsed lung putting pressure on the heart, or cardiac tamponade - blood building up around the heart and squeezing it to death). However, the circumstances leading to asystole are always catastrophic in nature, such that even if you manage to re-establish a rhythm (itself usually a losing proposition), the patient's chances of actual recovery are abysmal.
Regardless of what they were hospitalized for, if a character is hooked up to a cardiac monitor, they will almost always flatline at some point. Additionally it will either be an instant thing from a regular heartbeat to a line, or a very sudden series of erratic bleeps suggesting the patient is having a heart-attack, often from stress, just before the flatline itself. If the scene is being played for comedy, the "flatline" may be the result of the patient playing with the monitor leads, getting up for a bathroom trip, a guest accidentally tripping over the monitor, or other such mundane causes.
Rule of Perception says that a flatline on film is always... well, a flat line. However, in Real Life a recently asystolic patient would still show occasional waves on the screen, a condition also known as Pulseless Electrical Activity - the electrical signal to beat is being generated, but the heart muscle isn't responding anymore.
- In episode eleven of Ef a Tale of Melodies, Kuze's heart machine beeps and then the Heartwrenchingly sad ending theme plays. At the end his machine beeps again and he comes back to life.
- Code Geass: Euphemia.
- In Full Metal Panic: The Second Raid, Gauron flatlines after Sousuke shoots him repeatedly. However, the beeping actually starts up again (which lead to many people believing that he had officially achieved immortality). Of course, the beeping turns out to be a bomb.
- In Death Note, Soichiro was lying in the hospital bed and his death was shown by the long beep.
- In ET the Extraterrestrial, the fact that the life forces of ET and Elliot have been linked is indicated by electrocardiograms. As ET slowly dies, Elliot's own life signs get weaker and weaker. In the end, they both get better.
- In Sliding Doors, this occurs to Helen Quilley in one of the timelines as she dies in James' arms.
- Played for Laughs in Silent Movie.
- Happens with Neo in The Matrix and with Trinity in The Matrix Reloaded. They both get better.
- The three Human Popsicle astronauts killed by HAL in 2001: A Space Odyssey flatline. They don't get better. The computer display changes to "Life Processes Terminated."
- This also happened to Frank Poole, showing an entire battery of monitors slowly decaying to all flatline.
- Flatliners: As the title suggests, it happens many, many times.
- In Tank Girl, the head of Water and Power is indicated as dead by the flatlining of a display that showed pretty ocean waves becoming a placid surface of water. He actually survived ...sort of.
- In RoboCop 2. When Dr. Faxx shuts off Cain's life support system so his brain can be harvested.
- Used in the ending of Dr. Giggles. The surviving girl is hooked to an electrocardiogram, and we see her heart race increase as her love interest embraces her.
- Happens in Visiting Hours, when the Serial Killer Colt Hawker literally scares an old woman to death.
- Pretty much every show set in a hospital has done this, if not hundreds of times, then at least dozens. Though the best ones usually avert Magical Defibrillator.
- ER, being set in an emergency room, might be the record-holder, because sometimes this occurs three or four times per episode.
- Done in a very odd way during the credits of the last St Elsewhere episode. The MTM cat was shown lying still, flanked by a beeping heart monitor and IV bag. As the theme music ended, the monitor went to flatline instead of the kitty's traditional "Meow!" Yes, the autistic kid killed a kitty...
- ER, being set in an emergency room, might be the record-holder, because sometimes this occurs three or four times per episode.
- Dallas: The seventh-season ending, where Bobby Ewing dies; this is not the "shower scene" cliffhanger that aired a year later, but the episode where Bobby was struck by a car and mortally injured. As usually seems to be the case for "he's gonna die" episodes, the entire cast gathers at the victim's bedside (in this case, Bobby's) as the soon-to-be-deceased mumbles a few last words to family and loved ones; in this case, Bobby's last muttered words are, "I love you" before the flatline. Unintentionally comes off as being Played for Laughs because of the cheesy setup, the lack of emotion shown by a fake teary-eyed Larry Hagman, and the foregone conclusion that Bobby was going to die (due to Patrick Duffy leaving the show due to conflicts with the show's producers and writers -- until he got them resolved a year later ... ).
- Subverted in an episode of One Foot in the Grave. Margaret is hooked up to life support as Victor stays with her, holding her hand. The heart monitor does the standard "beep.. beep.. beep.. beep.. beeeeeeeeeeeeeeeep", and prompts a Really Dead Montage from Victor, and then a nurse wanders by, complains that the heart monitor had been faulty all week, bashes it, and apologises, as it starts beeping regularly again.
- Done repeatedly in Scrubs, of course.
- Daphne's death in Heroes.
- Battlestar Galactica used this in the sickbay a few times. Probably the best example is when Caprica miscarries and the internal baby monitor flatlines.
- This happens in the final episode of the 3rd season of Charmed, All Hell Breaks Loose. Piper is shot and dies in the hospital. Later that episode, time is reset and Piper is alive again.
- When Yousuke dies in Maou.
- Dollhouse basically does this when Paul gets mindwiped:
Computer monitor: SUBJECT: INACTIVE
- The Good Guys subverts this in the pilot episode. A plastic surgeon is operating on a criminal when a flatline occurs. The surgeon tells the guy's goons that it is probably just a loose wire but they do not believe him and pull out their guns. The doctor panics and the goons open fire, hit some oxygen bottles and blow themselves up. It really was just a loose wire.
- Subverted on on Chuck. In a season four episode, an attacker assaults someone who is gravely wounded in the hospital, and smiles when he sees the monitor flatline. Of course, the "victim" had merely unplugged his fingertip pulse-oximeter.
- Used for comedy in one episode of Home Improvement, Tim Allen takes applies 2 nodes to his chest, beep.....beep.....beep. He starts breathing heavily and tries again, beep..beep..beep..beep. He then puts the nodes on his head to which it flat-lines.
- Hospital scenes in Soap Operas seem fond of this trope. The setup is formulatic: The soon-to-be-departing cast member either is suffering from the final stages of an illness or is so severely hurt in an accident that the injuries cannot be healed and he/she is going to die, the character's family (or, especially if the character is a totally hot babe, just her boyfriend) gathers at bedside, the doomed character and several others share some tearful last words, and the flatline occurs, with rare attempts made by the doctors to resusitate the character.
- Gentaro at the end of episode 31 of Kamen Rider Fourze. He wasn't hooked to any machine, but there was a line on the screen meant to invoke this.
- Mac Taylor on CSI: NY. One of the doctors yells right out "He's flatlining!"
- Done for a little Comedic Sociopathy in Will and Grace. Rosario is in the hospital for tonsilitis, and Karen basically assumes she's faking for sympathy. Rosario flatlines, and Karen panics and spills her guts, saying she knew she was sick all along and just couldn't handle the idea of losing her. Rosario (who flatlined, remember) suddenly makes a snarky comment, them mentions that the reader came off her finger.
- Mocked in the video for "Weird Al" Yankovic's "Like a Surgeon", where a patient has flatlined just as Al (dressed as a doctor) walks in. Al attempts to give the machine Percussive Maintenance, but then realizes that the machine isn't the problem. He promptly pounds the patient in the chest... and his heart starts beating regularly again.
- The song itself ends with a *beep* *beep* *beeeeeeeeeeeeeeee*
- A flatline sound begins a song by thrash metal band Toxik that is, appropriately enough, titled "Heart Attack".
- A beeping sound begins and ends the song "The End", which is the start of My Chemical Romance's The Black Parade album. The sound returns at the end of the song, which moves instantly into the beginning of "Dead", where the beeping hits the flatline tone.
- "My Child" by Disturbed ends with this sound, being that it's about the lead singer's miscarried baby. Yes, he really wanted to be a father.
- The music video for the Travis Tritt song "Tell Me I Was Dreaming" does this by showing the letters ASY (meaning asystole, naturally), instead of the straight line and long beep that normally happens (forward to 3:28 to see it).
- The opening of Nexus' Return from Flatliner features a Heartbeat Soundtrack followed by this.
- Xorcist's "Crack" opens with a flatlining EKG; by the dialogue, a drug user apparently is having a Near-Death Experience after doing it the first time. "I didn't do that much stuff, it's only the first time! Oh God please, I wanna go back! "Oh please God, I wanna live!"
- The long, sustained G note during the song "My Iron Lung" by Radiohead sounds like a (take wild guess) a flat EKG. Considering the sardonic tone of the song, it's open to interpretation whether it means a person has died, or Radiohead is comparing their success as "dead"
- Experiment Four, Mr. 76ix's latest album, ends with this, and the last track is appropriately titled "Mors Janua Vitae".
- Tazz's entrance theme in WWE started with the sound of a heartbeat... which then fades into the beep of an ECG... which promptly flatlined.
- In one episode of The Very World of Milton Jones, Milton invents a checkout that can tell whether things are alive or dead. There follows a series of beeps (as he swipes items) followed by a long beep.
"I'm sorry, Ma'am, we've lost the broccoli."
- This was used with Nanako in Persona 4, although she gets better... unless you decide to kill her would-be murderer.
- Combine soldiers in Half-Life 2 emit a long beep every time you kill one.
- It also occurs every time you die in the first game.
- The flatline for the players death seems to be the HEV suit's monitoring system while the combine soldiers seems more like radio feedback.
- The ancient PC game Weird Dreams used this trope. The premise of the game was that the weird scenarios were literally a dying dream. The player character was actually in Intensive Care. If the player lost the game, he died. Highlighted by a graphic of a heart monitor's beep stuttering while it briefly flatlined if the player lost a life. Lose the last life and it stayed flatlined.
- Part of the sound effects in the Dance Dance Revolution track "Healing Vision", the "plot" being that the person is having a near death experience. The flatline is much more obvious in "Healing Vision: Angelic Mix"; in that version, the EKG's even rhythm devolves into chaotic fibrillation for about three or four measures before flatlining. The arrow targets stop momentarily to highlight the steady sound, which persists through the rest of the song until the final two beats (inverting Last-Note Nightmare nicely).
- In The Journeyman Project, a flatline tone is played upon Game Over.
- Syphon Filter 2, when Phagan is disconnected from life support.
- In Dead Space, this occurs when the wearer of a RIG dies, including NPCs as well as the player character.
- Happens when you die in Alien: Resurrection.
- In Illbleed, an electrocardiogram represents the player character's heartrate. Hit a scare trap and it goes up. If it gets too high, the character's heart explodes, and it flatlines. (It can also get too low if they bleed out, which also leads to death and a flatline.)
- Happens in the death sequence for Metroid Prime when the screen reads "LIFE SUPPORT SYSTEMS: OFFLINE" "GAME OVER"
- Happens in two different cutscenes of Oddworld: Munch's Oddysee. Interestingly the monitor used also shows lung and brain activity rather then just heart activity.
- The first is played for laughs when the new sonar placed on Munch's head zaps the nearby monitor briefly making it incorrectly show flatline causing Munch to freak out thinking he's going to die before the Vyker quickly gives it a quick smack making it go back to normal and Munch letting out a sigh of relief.
- The second one only happens if you get the Bad Ending (caused by not saving enough Fuzzles) which has Munch being killed by having his lungs cut out WHILE STILL ALIVE. The monitor is shown beeping rapidly while the sounds of the surgical tools and Munch crying out in pain are heard until it finally flatlines indicating Munch is well and truly dead
- In the South Park episode "Stanley's Cup," Nelson, the little boy with cancer, ends up flatlining after Stanley's team lost the game.
- In "Cartmanland", a hospitalised Kyle flatlines from stress when he hears of Cartman's huge financial success on TV.
- In The Simpsons, an April Fools prank leaves Homer in a coma. A teary-eyed Bart confesses that he pulled the prank, and as Homer's EKG beeps faster, the lines form the shape of Bart's head, just before he comes to and strangles Bart.
- Milhouse flatlines in a later episode while hospitalized for a broken leg. A second later, he tells Bart the monitor does that by mistake all the time.
- In Jackie Chan Adventures, Captain Black had been attacked by Valmont wielding the Dragon talisman. The end of the episode featured the long beep, only to reveal that Captain Black had just took off the sensors and tried to get out of the hospital.
- In the Invader Zim episode "Bad, Bad Rubber Piggy," Zim is keeping track of Dib's vital signs as he sends objects into the past to try and kill him -- after sustaining multiple injuries, he finally flatlines after Zim replaces the paramedic's defilibrator with rubber pigs. Unfortunately for Zim, he gets better.
- Played for laughs (yes, this is possible with this trope) in Courage the Cowardly Dog. Courage has a heart attack during a Wild Take in one episode. When he's recovering in Dr. Vindaloo's office, he grabs the doctor and runs off. The leads on his EKG snap off and it goes to flatline.
- In an episode of King of the Hill, Hank's father Cotton is able to cause a flatline at will using a trick he learned in the military. He does this several times in the episode, so when he actually does die everyone's a little unsure.
- Subverted in Action League NOW: "Danger for a Dignitary". After The Flesh accidentally gets an ambassador injured, Bill the Lab Guy is forced to do a delicate procedure to fix him:
Bill the Lab Guy: Nurse Thunder, I need more glue. (*flatline*) Oh no, I've lost him! I was afraid of this!
- In Hot Wheels Battle Force 5 Zoom flat-lines. Don't worry, he gets better.
- In Transformers: The Movie, Optimus Prime's vitals flatline towards the end of That Scene. Ouch.
- In Justice League Unlimited when Batman and the Flash are trapped in Justice Lord!Batman's holding cells, the Flash starts moving so fast that his heartbeat moves too fast for the machines monitoring him to keep up, making it look like a flatline. This causes Justice Lord!Batman to rush to the cell to check on him, at which point Flash drops the act and knocks Lord!Batman into the cell.
- In a rather serious episode of Adventure Time, this happens to Princess Bubblegum, but then she turns out alright.
- Unless it is a medical procedural like ER, the progression from a normal heartbeat--through various dysrhythmias and arrhythmias--to a flatline is usually depicted in fiction as unnaturally quick. Unless the patient suffered a catastrophic brain injury, decapitation, or a very high severing of the spinal cord, it usually takes several minutes for a patient to flatline as arrhythmias disrupt the flow of oxygenated blood to the brain. Except in rare cases, such as suppression by poisoning, extreme intoxication or extreme hypothermia, it is an extremely rare case that a patient who reaches asystole will be revived.
- Usually averted with modern monitoring systems, which often use alternate alarm sounds to avoid scaring patients and their families, precisely because the single long tone is so distinctive. The downside is that all alarm conditions frequently get lumped into the same "panic alert" category. This frequently leads to several minutes explaining to a panicked patient and/or family that no, they aren't really dying, it's merely a false alarm or a temporary deviation from normal (patient moved in bed, fell asleep, dislodged a monitor lead, etc).