EKG of the Week 2017 8-13

This EKG comes courtesy of Dr. Zhong and Dr. Zhi.

A 72 year old male with a history of schizoaffective disorder presents from a psychiatric center for lethargy and hypoxia.

Vital signs: Pulse 60, Respirations – 18, Blood Pressure – 107/76, O2 sat 80% on room air, Temp - 88.9.

His EKG is below.

2017 8-13.jpg

Because you have an awesome EKG tech, you are also presented with an old EKG on the patient (below).

2017 8-13 previous EKG.jpg

1.       What does the current EKG demonstrate?

2.       What is the clinical significance of this finding?

 

ANSWER:

The EKG demonstrates Osborn waves (best seen in leads V4-V6)

Osborn waves are seen in hypothermia.

 

The EKG shows a widened QRS complex with positive deflections at the end of the QRS complex in leads V4-V6. These deflections are called Osborn waves or J waves.

2017 8-13 with arrows.jpg

The EKG also shows ST elevations in leads V2 andV3. However, these were already present on the old EKG.

Hypothermia causes several EKG changes including bradycardia, lengthening of all intervals (PR, QRS, QT), atrial fibrillation and Osborn waves.

Osborn waves are deflections at the J point in the same direction as the QRS complex. The height of the Osborn wave is proportional to the degree of hypothermia. Osborn waves appear when the core temperature drops to approximately 87 degrees F (30.5 degrees C). The mechanism for the generation of Osborn waves is unclear, but it may be due to unequal depolarization and repolarization.

 

(Vassallo et al. A Prospective Evaluation of the Electrocardiographic Manifestations of Hypothermia. Acad Emerg Med 1999; 6:1121– 1126)