The following ECG findings are seen more frequently in patients with hypothermia (core body temperature < 35 C degrees)

  Tremor artifact

  Osborn wave (
J wave, Camel-hump sign, Late delta wave)

  Sinus bradycardia

  Atrial fibrillation

  Prolongation of the PR, QRS and QT intervals

  Asystole

  Ventricular fibrillation




Osborn wave - J Wave

  is defined as the elevation of the J point where the end of the QRS complex and ST segment merge.

  is best seen in precordial leads.

  increases in amplitude as hypothermia deepens.




Osborn waves ( J waves) may be seen in

  Hypothermia

  Major head injury

  Subarachnoid haemorrhage

  Hypercalcemia

  Acute coronary ischemia




References

  Anadolu Kardiyol Derg 2012 Dec;12:699-700.

  Emerg Med Clin N Am 2006;24:145-57.

  Tex Heart Inst J 2000;27:316-7.

  J Emerg Med 1989;7:169-73.

  Pacing Clin Electrophysiol 2007;30:817-9.

  Am J Physiol 1953;175:389-397.

  Neth Heart J 2012;20:379.

  Neth Heart J 2012;20:382-383.





ECG 1a. The ECG above was recorded from a 21 years-old man whose body temperature was 30.1 Celsius degrees.
Giant J waves (Osborn waves) are seen.


Click here for a more detailed ECG



ECG 1b. J waves disappeared after treatment of hypothermia.


Click here for a more detailed ECG

The ECGs above have been used with the permission of Anatolian Journal of Cardiology and AVES Publishing.

Click here to read the relevant article by Dr. Murat Yalcin et al.





ECG 2a. The ECG above belongs to a 47 years-old, alcoholic, homeless man who was found somnolent in the park, lying in a
pool of water. On admission, his body temperature was 31 Celcius degrees. Giant J waves (Osborn waves) are seen.
Other ECG features of hypothermia are also present: sinus bradycardia, tremor artefact and QRS/QT prolongation.


Click here for a more detailed ECG

The ECG above have been used with the permission of Netherlands Heart Journal.

Click here to read the relevant article by Pieters C and van de Poll SW.




ECG 2b. His ECG, after correction of hypothermia, is seen above.


Click here for a more detailed ECG

The ECG above have been used with the permission of Netherlands Heart Journal.

Click here to read the relevant article by Pieters C and van de Poll SW.