Images in Clinical Medicine

Giant Osborn Waves in Hypothermia

Mori J. Krantz, M.D., and Christopher M. Lowery, M.D.

N Engl J Med 2005; 352:184January 13, 2005

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A 47-year-old man with chronic schizophrenia was hospitalized after prolonged hypothermia. The initial electrocardiogram revealed Osborn waves (arrowheads) similar in amplitude to the R waves. Characteristic sinus bradycardia and prolongation of the QRS interval and the corrected QT interval (QTc) were also noted. During rewarming, the Osborn waves diminished in amplitude, and they disappeared after 24 hours. The baseline tremor artifact caused by shivering (arrows) resolved on normalization of the patient's core body temperature.

In 1953, Dr. John Osborn described the J wave as an “injury current” resulting in ventricular fibrillation during experimental hypothermia. More recent findings suggest that hypothermia increases the epicardial potassium current relative to the current in the endocardium during ventricular repolarization. This transmural voltage gradient is reflected on the surface electrocardiogram as a prominent J, or Osborn, wave. The differential diagnosis of prominent Osborn waves includes early repolarization, hypercalcemia, and the Brugada syndrome.

Mori J. Krantz, M.D.
Christopher M. Lowery, M.D.
Denver Health Medical Center, Denver, CO 80204-4507

Citing Articles (6)

Citing Articles

1. 1

   Christopher T. Buresh, G. Edgar Folk, Eric W. Dickson, Diana L. Thrift. (2010) Comparing hypothermia in the human and the black bear ( Ursus americanus ). Biological Rhythm Research 41:4, 247-257
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2. 2

   Gil J. Gross. (2010) Early repolarization and ventricular fibrillation: Vagally familiar?. Heart Rhythm 7:5, 653-654
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   Cabot, Richard C.Harris, Nancy Lee, Shepard, Jo-Anne O., Rosenberg, Eric S., Cort, Alice M., Ebeling, Sally H.Peters, Christine C., Sheridan, Robert L., Goldstein, Mark A., Stoddard, Frederick J. Jr., Walker, T. Gregory, . (2009) Case 41-2009. New England Journal of Medicine 361:27, 2654-2662
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   Georgios Papazisis, Thrasivoulos Tzellos, Dimitrios Tahmatzidis, Konstantinos Dolianitis, Dimitrios Kouvelas. (2009) Late-Onset Clozapine-Induced Hypothermia Accompanied by Electrocardiogram Osborn Waves. Journal of Clinical Psychopharmacology 29:2, 183-185
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   Turgut Karabağ, İsa Kılıçaslan, Ahmet Hulusi Arslan. (2008) Osborn waves in a hypothermic patient with head trauma. Canadian Journal of Cardiology 24:4, 318-319
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   Fahri Sahin, Ugur Onsel Turk, Figen Yargucu, Ayhan Donmez, Seckin Cagirgan. (2006) Hypothermia during the infusion of cryopreserved autologous peripheral stem cell causes electrocardiographical changes: Report of two cases. American Journal of Hematology 81:8, 627-630
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