The Osborn wave – a characteristic but not specific electrocardiographic change on severe hypothermia. Case report

Introduction: Hypothermia is a clinical syndrome characterized by a body temperature below 35°C. Seve-re hypothermia is cleary defined when the body tempe-rature is below 28°C.

Case presentation: T he case presentation refers to a 52 – year – old male homeless patient that was brou-ght on deep coma to the Emergency Departement of the County Emergency Clinical Hospital of Cluj with a accidental central body temperature of 22,5°C. The patient presented many cardiac electrical disorders on the electrocardiogram: atrial fibrillation, nodal rhytm, atrioventricular block of third degree. As for the ORS complexes there were seen the elongation of the QT/ QTc (0,80sec/0,50sec) and the presence of the Osborn wave. The blood tests indetified data in relation to a acute pancreatitis and rhabdomyolysis. After 4 hours of intensive care including the pro-gressive warm again, the electrocardiogram normali-zed and the patient recovered the sinus rhytm (with the absence of the Osborn wave) and the conscious mind. The subsequent evolution of the case was favorable.

Particularity of the case: The first characteristic is the suite of rhythm disorders, with life threating risk by the possibility of degeneration in ventricular fibrillation and/or asystole, commonly encountered when body temperature drops below 25°C (absent in our case at values of central body temperature of 22,5°C). Secondly, it is worth mentioning both the recovery of the state of consciousness and the sinus rhythm con-comitant with the disappearance of hypothermia.

Conclusions: The Osborn wave is characteristic for the severe hypothermia but no pathognomonic. It could be appear in vasospastic angina, hyperglycaemia, the subarachnoid haemorrhages or after cardio-respiratory stop. The occurrence of the wave in hypotermic context is secondary to the alteration of the ionic flux, evolving with the slow down of depolarization or with the early repolarization of the left ventricular wall.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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