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.
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 (but not always zero; a patient recovering from cardiac arrest is known as Lazarus syndrome, named after the man Jesus resurrects in the Gospel of John).
Regardless of what they were hospitalized for, thanks to The Law of Conservation of Detail, if a character is hooked up to a cardiac monitor, they will almost always flatline at some point. You definitely won't hear them if the character isn't going to die, because that beeping sound is just annoying. 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.
For a heartwarming spin on the trope (no pun intended), an unexpected flatline may be the result of a patient having suddenly recovered, then unplugging the machine to announce their survival to the world!
Rule of Perception says that a flatline on film is always... well, a flat line. In Real Life there might be a drifting baseline, but this is not true electrical activity. The flatline may also wave in time with the 50Hz or 60Hz of mains power, especially if a mains filter is not used or is faulty. There is also a condition called PEA (Pulseless Electrical Activity), distinct from asystole, where there is an organized rhythm on the monitor, but no pulse. The electrical activity is present, but the heart muscle is not responding. Both PEA and asystole are unshockable rhythms (the defibrillator will do absolutely nothing) and must be treated with continued CPR, epinephrine ASAP and then every 3-5 minutes, and attempting to reverse the causes of the rhythms—most commonly, hypovolemia and hypoxia.
As a Death Trope, all Spoilers will be unmarked ahead. Beware.
- 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 Kill la Kill, we see this in a flashback with a baby Ryuko during the time where her parents tried to infuse her with life-fibers. Subverted in that she wasn't dead.
- Vampire Hunter D: Bloodlust. After Grove sacrifices himself to save Leila from a vampire the audience can hear the flatline sound from the medical equipment attached to him.
- In Dragon Ball – Episode of Bardock, Lord Chilled flatlined after barely escaping Bardock's wrath.
- Excel♡Saga: Hyatt is hooked up to one for an ACROSS staff-meeting, of all things. Naturally, she flatlines half-way through prompting Excel to engage in extremely spazzy CPR. Played for Laughs, naturally, as Hyatt dies all the time anyway, and she gets better as usual.
- My Hero Academia: When Sir Nighteye succumbs to his injuries, the life equipment he was hooked onto flatlines, and the sound continues until the end of the chapter.
- In the Japanese version of Bakugan, the death of Shun's mother is made clear by the EKG suddenly flatlining. The English dub censored this scene and instead tried to make it like she fell into a coma.
- During the climactic battle at the end of The Dark Knight Returns, just when Batman has Superman at his mercy, we see Batman's pulse, represented by a red line on panel. It spikes incredibly rapidly and then flatlines, indicating his self-induced and temporary heart attack. It resurges on panel during his "funeral", just in time for Clark Kent to hear it with his Super-Senses.
- Gert's final page in Runaways shows her heartbeat interspersed between the panels. Then there's a shot of the fatal dagger penetrating her heart, overlapping the line going flat.
- Housepets! the Series has a false alarm variety. Peanut was in a coma after fending off a mad dog to save his family. The doctors are alerted to a Code Blue in his room, and they rush in...to find Grape hugging a miraculously-awaken Peanut. She hugged him so passionately, she dislodged his ECG leads.
- The My Little Pony: Friendship Is Magic The Moonstone Cup has Twilight's cardiac monitor do this. Because IT died, much to her chagrin ...
- Regret by Krazykatqueen has this with a dying Renko after Yukari (once Maribel Hearn) tells her she was sorry for her absence.
- In Kill la Kill AU, we have this with a mortally injured Ragyo, though we didn't really know if she died, as Amoridere wasn't sure what should come after that. It was later confirmed that she hadn't passed away.
- This occurs in Cellar Secrets, with a dying Shiro, in chapter 25. However, unlike how she'd normally respond to it, Ryuuko cries.
- In the Pokemon fanfiction, A Trial of Will, Ash is shot twice and eventually flatlines from a last-ditch attempt to heal him. Then the machine starts beeping again and he wakes up.
Ash: Uhh... hey, guys. Anyone care to tell me what just happened?
- In E.T. the Extra-Terrestrial, the fact that the life forces of ET and Elliot have been linked is indicated by electrocardiograms. As E.T. slowly dies, the link breaks and Elliot's own life signs get better while E.T.'s dive towards a flatline. In the end, E.T., too, gets better.
- In Sliding Doors, this occurs to Helen Quilley in one of the timelines as she dies in James' arms.
- The Man Without a Past: A man is brought to the hospital after a savage beating. He flatlines in his hospital bed, as the doctor and the nurse commiserate about how that's probably better than being left a vegetable. The doctor and nurse leave—and then the man revives, gets up, and walks out of the hospital. (He becomes an Amnesiac Hero.)
- The Matrix
- 2001: A Space Odyssey
- The three Human Popsicle astronauts killed by HAL 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 rate increase as her love interest embraces her.
- Happens in Visiting Hours, when the psycho killerColt Hawker literally cuts an old woman's oxygen tube and watches her die. When a nurse gets on the scene, she finds a corpse and a heart monitor doing flatline.
- Aliens. Several Marines have their vital signs monitors flatline when they're killed by Xenomorphs.
- Subverted in Apollo 13. The flight surgeon at the control room freaks out when the astronauts' monitors flatline, but they hear their voices through the radios fine, and the director assures him that the astronauts simply took their medical leads off. "A little medical mutiny" because they've been under a lot of stress and are tired of hearing the operators fuss about their heart rates.
- A clever and disturbing example in Mission: Impossible III. After rescuing his protege from the film's Big Bad, Ethan discovers she has had an explosive chip planted inside her head. During the escape he attempts to use a defibrillator to short out the chip before it can go off, but has to wait for it to charge first. The chip unfortunately detonates and kills her, with the defibrillator reaching full charge only seconds too late, whereupon it emits the singular "beep" to indicate that it is ready to be used, but tragically ends up acting as her flatline sound.
- Subverted multiple times in Young Doctors in Love. The best one is when the heroine flatlines, Downer Ending music and credits start, then she wakes up and one of the doctors finds the monitor got unplugged.
- In Guardians of the Galaxy (2014), the Downer Beginning has the hero's mother die in hospital on a flatline sound.
- Jurassic World: When the Asset Containment Unit gets wiped out trying to recapture the I. rex. As each operative dies, the people in the control room see their vitals flatline on a readout next to their name and ID photo.
- Resurrection features a heart monitor throughout the entire "near-death experience" scene, and yes it does flatline at one point.
- In Romy and Michele's High School Reunion, Michele's Dream Sequence ends 70 years in the future with Old!Romy flatlining as she gives Old!Michele the middle finger via video phone.
- Eraser. Johnny Casteleone is Playing Sick because We Need a Distraction. Unfortunately he yanks out the cords on the paramedic's heart monitor. Hilarity Ensues.
- In Quantum Apocalypse, Ben forgets to bring his blood pressure medication to Houston and has a heart attack just as he and Terry are arriving. He dies in the hospital a short while later.
- Dancing Trees: When Josephina is in the hospital after being shot, she makes Nicky promise to care for her autistic daughter Martha. Then she loses consciousness and flatlines a few seconds later.
- 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. As they are usually accurate with the medicine, typically this is handled accurately, with a flatline usually meaning they're done for. The rare occasions where they're not usually have good reasons why; in the final season, a child who was flatlining was found to have gotten into her uncle's medication, and treating the resulting overdose allowed her to be revived.
- Done repeatedly in Scrubs, of course.
- Ditto Emergency!, though they averted the Magical Defibrillator stuff.
- 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 rather upbeat theme music ended, the monitor went to flatline instead of the kitty's traditional "Meow!" Yes, the autistic kid killed a kitty...
- 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 apologizes, as it starts beeping regularly again.
- 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
Alpha: Huh. When did you die?
- 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 formulaic: 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 resuscitate 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 & 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.
- UFO (1970):
- In the episode "Identified", after a UFO is shot down, one of the aliens aboard it is captured. After he's exposed to the Earth's atmosphere, he suffers from Rapid Aging. As the SHADO doctors try to save him, a nurse watches a heart monitor. His heartbeat continues for a few seconds and then flatlines.
- In the episode "Computer Affair", Straker decides to use one of the "new anodynes" on a captured alien in the hope that it will act as a Truth Serum on him. Instead, it makes his heart beat faster and then kills him, with a heart monitor showing the whole thing.
- In the Intelligence (2014) episode "Patient Zero", Gabriel fakes one while he and Riley investigate how an executed death row inmate could turn up as patient zero in a virus outbreak. Gabriel lies down on the death chamber gurney (no syringes) and has Riley activate the system, then hacks the EKG machine with his chip to produce a flatline result (partly as a prank, but also to demonstrate that the machine was tampered with).
- Star Trek:
- Tricorders will tend to make the noise if the person being scanned dies. It's rarely actually shown, though, just the reactions of the people that are around.
- The sickbay biobed monitor will usually set off an alarm if the readings of the patient in the bed go beyond the normal range of its species (which means a biobed monitor set for human readings would go nuts if Spock got on the bed without the monitor being reset for Vulcans). In the Star Trek: The Original Series episode "Where No Man Has Gone Before", however, when Gary Mitchell demonstrates his newfound powers by willing himself dead for a few seconds, the monitor bottoms out all of the readings and falls silent, only to resume normal readings when he revives himself.
- On one episode of Barney Miller, Dietrich is hooked up to a stress monitor and goes out on a call. Back at the station, the monitor starts going haywire, which alarms everyone, and then flatlines completely, making them assume the worst. Then Dietrich walks back in wearing department sweats—the disturbance was a woman attacking her husband with a fire hose, and in the "crossfire" the sensors shorted out.
- The final episode of Season 13 of Canada's Worst Driver opens with host Andrew Younghusband "operating" on the Camaro that was the hero car for the season, with it supposedly hooked up to the electrocardiogram. Despite his best efforts with the jumper cables ("Don't you do this to me!"), it flatlines.
Andrew: Nurse, I'm gonna call it. This 2017 Camaro SS is dead.
- Kolchak: The Night Stalker, episode "The Devil's Platform". Robert Palmer's secretary is in the hospital suffering from dog bite wounds. Palmer shows up in her room and fools around with her IV drip. As she dies, her heartbeat monitor changes from a steady series of blips to a flatline.
- Starsky & Hutch: After being critically injured in the series finale, Starsky has one of these. Resuscitation attempts fail and the doctor is about to call it... until Hutch races in and Starsky's heart starts beating again.
- Devon's father does this in the Midnight Caller episode "Fathers and Sins."
- In the Broad City episode "The Last Supper," Abbi and Ilana are in a hospital room, being treated for glass shard cuts and a Self-Induced Allergic Reaction, respectively. In the room next to theirs, they hear a man flatlining, then being declared dead.
- Happens with Brennan’s dad Max as part of his Heroic Sacrifice saving his grandkids from Kovac on Bones. He’s had surgery and is talking to Brennan and then he suddenly flatlines and the machines go nuts. He doesn’t survive.
- The early prototype versions were used in M*A*S*H where instead of an electronic display it consists of several needles being dragged across paper. Although the distinctive noise was absent there were plenty of dramatics moments where a patient flatlined, forcing the surgeon to leap into emergency procedures.
- Played for laughs in an episode of Titus. Christopher is talking to his dad who is in the ICU for a suspected heart attack. As they are talking, his dad suddenly flatlines prompting the arrival of the emergency resuscitation team who try to use the defibrillator on him. The problem is, Chris' dad is still very conscious and coherent and is clearly not suffering from cardiac arrest. A quick check by the duty nurse reveals they accidentally switched the electrocardiograms with the patient next door who is very dead.
- The penultimate episode of Lab Rats, "Space Colony", has a surprisingly harrowing instance of this for a Disney TV show, even if it's ultimately subverted. As Adam flies into the Earth's atmosphere to stop Dr. Gao's doomsday rocket, his vital signs gradually drop until he flatlines completely, much to the horror of Bree, Chase and Principal Perry, who, for a few seconds, believe that he didn't make it; however, it quickly turns out he had just passed out.
- Subtly hinted in Porter Robinson's "Goodbye to a World," where the last word is suddenly held until the end of the song not unlike a electrocardiogram machine flatlining.
- 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*
I can feel your heartbeat/ For the very last time...
- 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 (sampled from a 1980's anti-drug ad), 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 a wild guess) 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 2012 album, ends with this, and the last track is appropriately titled "Mors Janua Vitae".
- "Pink Cigarette" by Mr. Bungle has the sound of an EKG slowly enter the mix near the end of the song... It then flatlines, abruptly interrupting the music and lyrics mid-sentence. And all this happens when the narrator of the song starts counting down the hours "until you find me dead".
- Guns N' Roses has Coma, a song about a man on his deathbed embracing his own death. It's interspersed with a beeping ECG in time with the percussion. Naturally, he flatlines at the point where he realizes he's actually afraid of dying, as indicated by the long beeeeeeeeeeep and all the medics calling a Code Blue.
- In Rarity (a.k.a. Jeff Burgess)'s song Goodbye, the beeping comes in on the very last note, forming a harmony with the two vocalists. The vocals end just before it flatlines, leaving the long beep as the only thing you hear for the last ten seconds of the track. It's not entirely clear which vocalist's character has died.
- An EKG flatline sample can be heard in parts of Covenant's Leaving Babylon II."
- K-Pop boy bang Big Bang's music video for "Haru Haru" ends with the sound of a flatline.
- Kikuo's Vocaloid composition "Don't Look at Me That Way" has a childish spin on it, much like the rest of the song. While the singer (a little boy) is having his last thoughts while leaving the mortal plane, his final line "oh" is backed by a drawn out, high pitched recorder note.
- Used in The Machine: Bride of Pin*Bot not to indicate death, but a new life beginning - when activating the Bride's transformation from robot to human, the table goes dark except for a flatline across the score display and the familiar long beep... then a thumping bass heartbeat begins, accompanied by pulse waves on the score display, increasing in tempo as the Bride comes to life.
- 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.
Milton: I'm sorry, Ma'am, we've lost the broccoli.
- Parodied in The Complete History Of America Abridged, where the narration of The American Civil War has a beep between each of the slides (which get lost due to a stage mishap, forcing the actors to compensate). After the narration winds up with Abraham Lincoln getting shot by John Wilkes Booth and dying the morning after, there is a really long beep. (Seconds later, the same effect is repurposed as a Sound-Effect Bleep as the announcers start arguing with each other.)
- Heard in Feathers and Teeth when Chris recounts her mother's death, and when Carol kills Chris at the end.
- The vintage Tamagotchi releases and the first several Digimon V-Pet releases have a heart monitor and flatline as part of their death sequences. Outside of possibly laying an egg at the end, they are completely unresponsive throughout the whole process and likely following the same ECG patterns of an actual asystolic patient, with the heart rate gradually slowing down rather than going from a normal rate to the flatline in a couple of seconds. On the releases where a character can be recovered from the brink of death, the heart monitor sounds are not part of the death sequences at all.
- This was used with Nanako in Persona 4, although she gets better... unless you decide to kill her would-be murderer.
- In every Half-Life series title (barring Half-Life: Blue Shift and Half-Life: Alyx), the player character's Powered Armor will emit a flatline beep whenever they die.
- 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 DanceDanceRevolution 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); to lay it on more the rest of step chart until those final two beats on Heavy/Expert is a continuous stream of eigth-note steps without any kind of break, 132 arrows in all.
- In The Journeyman Project, a flatline tone is played upon Game Over.
- Syphon Filter 2, when Phagan is disconnected from life support.
- The introduction for Cyborg Justice has the flatline for the human pilot that dies, which is then replaced by a square wave.
- In Dead Space, this occurs when the wearer of a RIG dies, including NPCs as well as the player character.
- Your Neural Cyberspace Interface implant in System Shock has a HUD with Multiple Life Bars that show your heartbeat, brainwaves, and other life signs. The heart rate spikes if your fatigue is too high, and if it flatlines, it's game over. The HUD even fills with static when this happens.
- Used for player character death in Alien: Resurrection Licensed Game.
- In Illbleed, an electrocardiogram represents the player character's heart rate. 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."
- Also in Metroid Prime 2: Echoes during its death sequence. It beeps fast at the beginning, and flatlines when the screen reads "FAILURE. MISSION FAILURE" "GAME OVER".
- At the beginning of Fallout 3, Catherine, the player character's mother, has this when she goes into cardiac arrest after childbirth. Also heard when you find her skeleton during the Punga hallucination in Point Lookout.
- In Capcom vs. SNK 2: Mark of the Millennium, defeating one of the True Final Bosses (Shin Akuma or God/Ultimate Rugal) results in a visual of an EKG going flatline intersticed with the defeated boss's death scene.
- Since you spend most of the game going through a dying man's dreams, To the Moon has his electrocardiogram displayed on the top of the screen. His heartbeat gets more and more frantic and erratic as the game goes on. Although you never see it, you eventually hear him "flatline" near the end of the game.
- In Live A Live, after Kirk's spacesuit has its life support system mysteriously switched off, he is brought in and taken to the sickbay, where he flatlines.
- Sunset Overdrive has this sound when the player character dies, preceded by a Critical Annoyance EKG beep.
- In the controversial Grand Theft Auto V mission "By the Book", Trevor has to torture Ferdinand Kerimov to get information for crooked FIB agent Steve Haines, so Michael can assassinate a target. Kerimov is hooked up to an ECG monitor, and Trevor has to monitor his heart rate during the torture sessions. If Trevor goes too far in his torture and Kerimov flatlines, Trevor can revive him up to three times with an adrenaline shot; however, if Trevor fails to revive Kerimov in time or runs out of adrenaline to do so, Kerimov will die and Haines will chew out Trevor, failing the mission.
- Harvester has this in two death scenes (with Steve being electrocuted to death or having his head sliced off). However, this flatline comes into play later on in the good ending, in which two scientists were using the EKG to test Steve to make him a murderer in the virtual world, but they failed since by sparing his girlfriend, Steve died too early before he became a killer, and thus they decide to continue their plan to make killers of more victims, and the flatline shows as the two scientists do an Evil Laugh.
- Skullgirls had a character named Valentine, and one of her supers involves her slicing the opponent as a EKG beeps, with the final hit being a flatline.
- In the last story of Sonic Battle, this is Emerl's final fate. A series of beeps slowly begin, then speeds up, before finally ending with a final series of very fast beeps that resemble a flatline. Emerl then disappears. Shadow reveals that if Emerl went out of control, the bio-weapon will terminate itself.
- In The Spectrum Retreat, the sound of the flatline is how Robin's death is presented.
- One is used near the end of Spider-Man (PS4) to signify Aunt May's succumbing to Devil's Breath. Peter has a cure that can be used to heal one person now or be used to make more samples for the other victims. He is unable to bring himself to use the cure for her and she encourages him not to. He then breaks down in tears by the bed and the screen cuts to black with only the sound of Aunt May's heart patterns...which suddenly stop.
- The DOS surgery simulator Laser Surgeon: The Microscopic Mission fittingly has this when a patient dies, following the chaotic "critical condition" beeping.
- One of the tracks in Theme Hospital ("Candyfloss") works a heart monitor beep into the music, which includes long notes meant to be a flatline sound.
- Trauma Center: The vitals bar has an ECG overlaid which, of course, flatlines when a patient undergoes cardiac arrest. A flatline is usually accompanied by intense ECG waves beforehand (due to ventricular fibrillation). When this happens, it's time to either break out the Magical Defibrillator or perform a heart massage.
- The series occasionally gets it accidentally right; Trauma Team includes a cutscene with chest compressions in the absence of a defibrilator. In the event of an open chest cavity, direct heart massage is sometimes used to restore pulse. However, most gameplay has the player stop operating during fibrilation, and only use the defibrilator after flatline, which is exactly backwards.
- Blue Reflection: Second Light: As Yuki reveals to the rest of cast she's been Dead All Along the typical flatline sound effect plays.
- Used in Code Lyoko three separate times. The first episode to use this trope is "Killer Music" (Odd); the second, "Common Interest" (Aelita); and the third time "The Pretender" (Yumi).
- 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.
- Kenny flatlines at the end of "Chickenpox".
- The Simpsons:
- In "So It's Come To This: A Simpsons Clip Show", 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.
- This was also parodied in "Faith Off", with Bart talking to an injured Milhouse who is hooked up to an EKG. While Milhouse is still alive, the monitor flatlines.
Milhouse: Oh, it always does that. HUNGH! (hits monitor, the monitor starts again)
- Subverted In the Spongebob Squarepants episode "All that Glitters" SpongeBob is seen at the infirmary after he tries to replace his spatula with a high tech new one that deserts him:
- [scene cuts to the spatula's hospital bed from the start of the episode, with the pulse meter slowing, then becomes a flat line]
SpongeBob: Spatula?? It can't be true. It's too late!! [sobs uncontrollably]
Doctor: SpongeBob, I-I hate to tell you this...
SpongeBob: I know. He's moved on to the big kitchen drawer in the sky. He's gone!
Doctor: Actually, it's not that. I didn't get the acting part.
SpongeBob: [sobbing] I'm so sorry... [sobbing continues]
Doctor: Oh, by the way, that's not your spatula. Your buddy's all patched up in the infirmary.
- [scene cuts to the spatula's hospital bed from the start of the episode, with the pulse meter slowing, then becomes a flat line]
- 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.
- Ned's Newt, episode "Draw Your Own Concussion": An inversion of this occurs when the monitor flatlines after the doctors remove the ECG pads from Ned following their remark that he's cured.
- 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!
Thunder Girl: Goody! Popcorn's done. [opens microwave; beep stops]
- 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 when the League is 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 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.
- The first episode of Ultimate Spider-Man (2012) had Peter explaining to Aunt May that he's all right after his school was ambushed by the Frightful Four, but couldn't say the same for Harry, who wound up in the hospital. We cut to a heart monitor flatlining as if he had died, but it was just being switched off and wheeled out of his room by a nurse.
- Parodied in the Oggy and the Cockroaches episode "Face Off". While Jack is looking at Oggy's messed-up face, the monitor flatlines. However it starts beeping again until an Expy of Pac-Man eats the lines. This is followed by brief Pong gameplay. Apparently Joey was behind the monitor strangeness the whole time.
- Spoofed in Family Guy, where one of the inventions Peter comes up with when he takes over his father-in-law's company is the "African-American Heart Monitor". Instead of beeping, it plays a clip of a black man saying "Yeah, yeah, yeah"; in place of the familiar flatline sound, the voice simply says "Aw, he dead."
- 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. Usually this is simply a case of Law of Conservation of Detail . 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.
- Even in cases of extreme Central Nervous System trauma (brain injury, severed spinal cord, etc) the heart can continue to beat with a detectable rhythm for up to 30 minutes after brain death. In 1887 a sphygmograph (a crude early heart monitor that drew a pulse pattern onto carbon paper) was used to monitor the pulses of three hanged men. You can see the resulting traces here.◊
- Modern ECGs, including handheld ECG machines carried by ambulances such as this one, as shown in this British documentary still have specific tones for flatlines, but also sound off a series of beeps (in this case, three short and one long) to signal if the machine has merely been disconnected instead.
- A potentially catastrophic aversion to this is "pulseless electrical activity", or PEA. That's where the brain is sending the signals to the heart to establish heartbeat, but the heart isn't responding. So the monitor is beeping normally, while the patient looks dead as a doornail. This can happen with extreme physical restrictions to the heart muscle like pneumothorax or tamponade, or an extremely well-placed injury to the heart muscle that affects the nerves that transmit those signals.
- 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.).
- The "played for comedy" flatline, as described in the introduction, is actually quite a common occurrence. The electrodes can easily slip off the skin, and since the regular beep volume is usually turned down low, nobody notices the irregular signal on the monitor until the flatline beep (or alternative alert) sounds. So there are many false alarms. It's not uncommon for an annoyed patient ostensibly hooked up to one of these to buzz for a nurse because the flatline tone is interfering with their sleep/TV show/whatever.