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Perm J. 2010 Fall; 14(3): 73.
Published online Fall 2010.
PMCID: PMC2937849

ECG Diagnosis: Hypothermia

Joel T Levis, MD, PhD, FACEP, FAAEM

An Osborn wave (also referred to as the J wave) is a characteristic ECG finding for hypothermia consisting of an extra deflection on the ECG at the terminal junction of the QRS complex and the beginning of the ST-segment takeoff.1 Osborn waves usually occur when the core body temperature falls below 90°F (32°C), and are believed to result from an exaggerated outward potassium current leading to repolarization abnormality.2 They can also be found in other conditions such as hypercalcemia.3 Other ECG findings in patients with hypothermia can include prolongation of the PR, QRS and QT intervals, T wave inversions, and various dysrhythmias including atrial fibrillation, sinus bradycardia, atrioventricular block, and ventricular fibrillation. Fatal ventricular fibrillation or asystole can occur in hypothermic patients when core body temperature falls below 82.4°F (28°C).1

Figure 1
12-lead ECG from a man, age 38 years, with somnolence, altered mental status and core body temperature of 86°F (30°C)
Figure 2
12-lead ECG from same patient following rewarming to a core body temperature of 92°F (33.3°C)


  • Mareedu RK, Grandhe NP, Gangineni S, Quinn DL. Classic EKG changes of hypothermia. Clin Med Res. 2008;6(3–4):107–8. [PubMed]
  • Olgers TJ, Ubels FL. The ECG in hypothermia: Osborn waves. Neth J Med. 2006 Oct;64(9):350, 353. [PubMed]
  • Van Mieghem C, Sabbe M, Knockaert D. The clinical value of the ECG in noncardiac conditions. Chest. 2004 Apr;125(4):1561–76. [PubMed]

Articles from The Permanente Journal are provided here courtesy of Kaiser Permanente