JCHIMP 2000-9666 Journal of Community Hospital Internal Medicine Perspectives Vol. 1, January 2012, pp. 1–2 sici xxx PUBMED Abbreviation Sami W. Serafi BA

*Sami W. Serafi, American University of Antigua, Union Memorial Hospital Baltimore MD USA

Crystal Vliek MD Mahnaz Taremi MD Union Memorial Hospital American University of Antigua

Baltimore MD USA

Union Memorial Hospital Department of Cardiology

Baltimore MD USA

Union Memorial Hospital Department of Medicine

Baltimore MD USA

Journal of Community Hospital Internal Medicine Perspectives ORIGINAL ARTICLE Osborn waves in a hypothermic patient Osborn waves on admission ECG can be seen clearly in the precordial leads. Arrows point to Osborn waves.

Osborn waves resolved 48 hours after admission.

The J wave is also known as an Osborn wave, camel-hump sign, late delta wave, hathook junction, and hypothermic wave 1. The prominent J deflection attributed to hypothermia was first reported in 1938 by Tomaszewski. Over time, the wave has increasingly been referred to as an Osborn wave, in most part due to Osborn's 1953 article in the American Journal of Physiology on experimental hypothermia 2. An Osborn wave is characterized as an extra deflection of the terminal junction of the QRS complex and the start of the ST segment 3. Typically, the deflection at the J point is in the same direction as that of the QRS complex 4. It is more commonly observed in leads II, III, AVF, V5, and V6. The J wave disappears with normothermia 5. This deflection has been attributed to delayed depolarization, to a current of injury, or to early repolarization. In leads that face the left ventricle, the deflection is positive and its size is inversely related to body temperature 6. The earliest morphologic abnormality in patients with mild hypothermia is a tremor artifact due to the shiver response. This is non-specific and becomes uncommon at core body temperatures less than 32°C as the body's ability to generate a shiver response diminishes. As core body temperature approaches moderate hypothermia, we find the appearance of the J waves. J waves can be considered highly suggestive of hypothermia but are not considered to be pathognomonic 3. Conditions other than hypothermia have been reported to cause an abnormal J wave deflection such as hypercalcemia, brain injury, subarachnoid hemorrhage, damage to sympathetic nerves in the neck, and cardiopulmonary arrest from oversedation 2. A deflection similar to the J wave is also present in patients with Brugada syndrome 7. J waves have no relationship to pH, sodium, potassium, or chloride concentrations 3. The authors have not received any funding or benefits from industry or elsewhere to conduct this study. Aydin M Gursurer M Bayraktaroglu T Eyup Kulah Onuk T. Prominent J Wave (Osborn Wave) with coincidental hypothermia in a 64-year-old woman Texas Heart Insti J 2005 32 1 105 Hurst JW. Naming of the waves in the ECG, with a brief account of their genesis Circul J Ameri Heart Assoc 1998 98 1937 42 Brady WJ Jonathon DT. Critical decisions in emergency and acute care electrocardiography1st ed Wiley-Blackwell Hoboken USA 2009 381 2 Wagner GS. Marriott's practical electrocardiography, 10th ed Lippincott Williams & Wilkins Philadelphia 2001 221 Topol EJ Robert MC Eric NP Jeffrey MI Judith LS. Textbook of cardiovascular medicine2nd ed Lippincott Williams & Wilkins Philadelphia 2002 1350 1 Fuster V O'Rourke RA Walsh RA Poole-Wilson P. Hurst's the heart12th ed McGraw Hill New York 2008 316 7 Surawics B Knilans TK. Chou's electrocardiography Clinical Practice5th ed Lyn Carmire Marc Mugman W.B. Saunders Company Philadelphia 2001 532 3