Osborn wave

Q: 48 years old homeless male is brought to ED at Chicago downtown hospital with severe hypothermia. EKG was found to have a characteristic J point elevation (Osborn wave). J point elevation in hypothermia correlates with the degree of hypothermia?

A) Yes

B) No

Answer: A

Along with bradycardia hypothermia produces a classic J point elevation, known as Osborn wave. This elevation correlates with the degree of hypothermia. Osborn wave can be best seen from lead V2 to lead V5. Care should be taken to make sure that any other ST-segment elevation is not missed due to this wave. 

It is essential that a clinician personally evaluates all EKGs in hypothermia so as not to miss any cardiac ischemia findings (automatic machine readings may not be reliable).

Said that many other conditions can give similar EKG appearance such as early repolarization, hypercalcemia, and Brugada syndrome. Although suggestive of hypothermia, subarachnoid hemorrhage (SAH), and traumatic brain injury (TBI).

#cardiology

#hypothermia

References:

1. Doshi HH, Giudici MC. The EKG in hypothermia and hyperthermia. J Electrocardiol 2015; 48:203. 

2. Graham CA, McNaughton GW, Wyatt JP. The electrocardiogram in hypothermia. Wilderness Environ Med 2001; 12:232. 

3. Salinski EP, Worrilow CC. ST-segment elevation myocardial infarction vs. hypothermia-induced electrocardiographic changes: a case report and brief review of the literature. J Emerg Med 2014; 46:e107.