Dawn's picture

This is one of the best depictions of Osborn waves you will find.  It was first published on FaceBook, on the EKG Club group.  The owner of this tracing, Marc Berenson, has graciously allowed us to publish it here for the use of our members.

This ECG is from an unresponsive patient with a Glasgow Coma Scale of 3.  His core temperature was 86 degrees F (30 degrees C).  He was not moving or shivering. He was found to have a brain mass with bleeding, causing herniation of the brain stem. 

Osborn waves are caused by hypothermia, and also by a number of other conditions.  They are best described as an “extra” wave at the J point (junction of the QRS complex and ST segment).  They are sometimes called “camel hump waves”.  Hypothermia can also cause many other cardiac problems, including prolongation of the PR interval and QT interval, arrhythmias, and eventually asystole.

In this case, the hypothermia was probably caused or exacerbated by the patient’s loss of thermoregulation due to the brain bleed.  Neurological insults such as subarachnoid hemorrhage, and head trauma can cause Osborn waves, and this patient certainly was in that category, along with being demonstrably hypothermic.  Other causes of Osborn waves include hypercalcemia, some medications, and as a normal variant. 

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ekgpress@mac.com's picture

     As per Dawn - very nice example of Osborn Waves that are characteristic of Hypothermia. But in addition - there is: i) a LONG QT; and ii) Peaked and pointed T waves in multiple leads. Sounds like the patient had a CNS catastrophe (herniation from mass with bleed) - and that could account for the long QT. We wonder about HyperKalemia - given those tall, peaked T waves. If not hyperkalemia - then the CNS disorder may account for the T wave peaking with the long QT interval.
  • A question that often comes up is how to distinguish the J-point notching of ERP (Early Repolarization Pattern) from the Osborn waves of Hypothermia. History obviously helps (ie, knowing the temp = 86F) - BUT this ECG is clearly not typical of simple ERP because: i) The QT is prolonged (if anything, the QT tends to be short with simple early repol); ii) The T waves are clearly more pointed than is generally the case with simple early repol; iii) In those leads in which the T wave is inverted (leads aVR,aVL; V1,V2) - the negative T waves are clearly more pointed than I'd expect with simple early repol; iv) You usually do NOT have T inversion in lead V2 in an adult with simple early repol (esp. NOT this deep T inversion in V2); and v) The J-point notching is present in almost all leads (I,II,III,aVR,aVF and V1-thru-V6) - and early repolarization would not be expected to produce global J-point notching.
  • Click here for more on Early Repolarization
  • Click here for more on Hypothermia (this pdf excerpted from ECG-2014-ePub) - 

Ken Grauer, MD  www.kg-ekgpress.com   [email protected] 

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