Case Report

Osborn Waves in Sepsis

Authors: Gustavo A. Cardenas, MD, Hector O. Ventura, MD, John E. Francis, MD

Abstract

A patient with severe sepsis, who presented with moderate hypothermia and the classical electrocardiographic findings that have been described in patients with accidental hypothermia is presented. Rewarming was associated with proportional improvement of the initial electrocardiographic abnormalities. A brief discussion is included about the electrophysiologic mechanisms of Osborn waves, the differential diagnosis of this electrocardiographic finding as well as other findings described in patients with hypothermia.


Key Points


* Hypothermia causes asymmetric distortion of the earliest phase of membrane repolarization between the epicardium and endocardium, manifested as J-wave or Osborn wave.


* Sepsis-induced hypothermia can have similar electrocardiographic manifestations as accidental hypothermia.


* Differential diagnoses of Osborn waves include hypothermia, hypercalcemia, early repolarization and Brugada syndrome.


* Other electrocardiographic manifestations of hypothermia include supra- and ventricular arrhythmias as well as conduction abnormalities.

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References

1. Osborn JJ. Experimental hypothermia: respiratory and blood pH changes in relation to cardiac function. Am J Physiol 1953;175:389–398.
 
2. Gussak I, Bjerregaard P, Egan TM, et al. ECG phenomenon called the J wave: history, pathophysiology, and clinical significance.  | J Electrocardiol 1995;28:49–58.
 
3. Yan GX, Lankipalli RS, Burke JF, et al. Ventricular repolarization components on the electrocardiogram: cellular basis and clinical significance. J Am Coll Cardiol 2003;42:401–409.
 
4. Alsafwah S. Electrocardiographic changes in hypothermia. Heart Lung 2001;30:161–163.
 
5. Yan GX, Antzelevitch C. Cellular basis for the electrocardiographic J wave. Circulation 1996;93:372–379.
 
6. Mattu A, Brady WJ, Perron AD. Electrocardiographic manifestations of hypothermia. Am J Emerg Med 2002;20:314–326.
 
7. Kalla H, Yan GX, Marinchak R. Ventricular fibrillation in a patient with prominent J (Osborn) waves and ST segment elevation in the inferior electrocardiographic leads: a Brugada syndrome variant? J Cardiovasc Electrophysiol 2000;11:95–98.
 
8. Okada M. The cardiac rhythm in accidental hypothermia. J Electrocardiol 1984;17:123–128.