71 year old intoxicated patient found lying outside in the cold. Core temp 83 degrees.
The Osborn wave (J wave) is a positive deflection seen at the J point in precordial and true limb leads. It is most commonly associated with hypothermia. These changes will appear as a reciprocal, negative deflection in aVR and V1.
Osborn Wave Causes
Characteristically seen in hypothermia (typically T < 30C), but they are not pathognomic. Causes of non-hypothermic Osborn waves include:
Acute myocardial ischaemia [Maruyama et al]
Left ventricular hypertrophy due to hypertension [Patel et al]
Normal variant and early repolarization
Neurological insults such as intracranial hypertension, severe head injury and subarachnoid haemorrhage
Le syndrome d’Haïssaguerre (idiopathic VF)
No definitive physiological cause for the deflection has been described, despite numerous postulates.
Compared to other hypothermia-induced ECG abnormalities (e.g. sinus bradycardia; supraventricular arrhythmias, QT prolongation and AV block), the Osborn wave is thought to be the most specific.