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images in clinical medicine

Giant Osborn Waves in Hypothermia

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Temperature (C)
Heart rate (beats/min)
QRS interval (msec)
QTc interval (msec)

Mori J. Krantz, M.D.

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

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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 patients 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.
Copyright 2005 Massachusetts Medical Society.

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184

n engl j med 352;2

www.nejm.org

january 13, 2005

The New England Journal of Medicine

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