This EKG comes courtesy of Dr. Ben Chill.
A 50 y/o male with a history of adrenal insufficiency presented with altered mental status.
V/S: P – 55, R – 12, BP 90/60.
His EKG is below.
1. What does the EKG demonstrate?
2. What is the significance of this finding?
3. How would you manage the patient?
The EKG shows Sinus bradycardia with Osborn waves.
It suggests hypothermia.
The patient should be treated with rewarming.
The EKG demonstrates a widened QRS complex with positive deflections at the end of the QRS complex in leads V2-V6. These deflections are called Osborn waves or J waves. This suggests hypothermia.
Although this case occurred during this time of year, when it is not cold outside to cause environmental hypothermia, our patient had adrenal insufficiency. His core temperature was 88 degrees F.
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 typically 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.
Our patient was treated with rewarming. Because the underlying cause was adrenal insufficiency, he was also treated with parenteral steroids. He was admitted to the ICU.
(Vassallo et al. A Prospective Evaluation of the Electrocardiographic Manifestations of Hypothermia. Acad Emerg Med 1999; 6:1121– 1126)