Osborn wave
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Synonyms and keywords: camel-hump sign; late delta wave; hathook junction; hypothermic wave; J point wave; K wave; H wave; current of injury; Osborne wave
Overview
Osborn waves (also known as ) are usually observed on the electrocardiogram of people suffering from hypothermia, though they may also occur in people with high blood levels of calcium (hypercalcemia), brain injury, subarachnoid hemorrhage, damage to sympathetic nerves in the neck, and cardiopulmonary arrest from over sedation, vasospastic angina, or ventricular fibrillation. [1] [2] [3] [4]
Historical Perspective
The prominent J deflection attributed to hypothermia was first reported in 1938 by Tomaszewski. The wave was observed by others, including Kossmann, Grosse-Brockhoff and Schoedel, Bigelow et al, Juvenelle et al, and Osborn. [5] [6] [7] [8]
Over the years, the unusual wave has increasingly been called an Osborn wave, probably because of Osborn's excellent descriptive article written in 1953. Clinicians labeled the deflection an Osborn wave in honor of Osborn, one of the first American Heart Association research fellows. [9] [10]
Causes
- Cerebrovascular accident[11] [12]
- Coronary vasospasm
- Damage to sympathetic nerve chain in the neck after radical neck dissection [13]
- Hypercalcemia
- Hypothermia
- Subarachnoid hemorrhage[14]
- Ventricular fibrillation
Diagnosis
Electrocardiogram
Osborn waves are positive deflections occurring at the junction between the QRS complex and the ST segment, where the S point, also known as the J joint, has a myocardial infarction-like elevation.
All J wave deflections do not look alike. Some are merely elevations of ST segments in leads V1 and V2, whereas others are of the spike-and-dome variety. This leads to the conclusion that different mechanisms may be responsible for the size and shape of J wave deflections.
Electrocardiographic Examples
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![The time course of twelve-lead ECG in a 52-year-old man with vasospastic angina. ECGs were obtained prior to the ischemic attack (A), at the onset of chest pressure (B), immediately before ventricular fibrillation (C), after defibrillation and administration of intravenous lidocaine and magnesium (D), and 2 days after the episode (E). Osborn waves (arrowheads) were best seen in the inferior and lateral leads around the occurrence of ventricular fibrillation. In contrast to hypothermic patients, the tracing shows sinus tachycardia and short QT intervals.[15]](/images/2/2f/Osborne_example.jpg)
The time course of twelve-lead ECG in a 52-year-old man with vasospastic angina. ECGs were obtained prior to the ischemic attack (A), at the onset of chest pressure (B), immediately before ventricular fibrillation (C), after defibrillation and administration of intravenous lidocaine and magnesium (D), and 2 days after the episode (E). Osborn waves (arrowheads) were best seen in the inferior and lateral leads around the occurrence of ventricular fibrillation. In contrast to hypothermic patients, the tracing shows sinus tachycardia and short QT intervals.[15]
![The time course of twelve-lead ECG in a 52-year-old man with vasospastic angina. ECGs were obtained prior to the ischemic attack (A), at the onset of chest pressure (B), immediately before ventricular fibrillation (C), after defibrillation and administration of intravenous lidocaine and magnesium (D), and 2 days after the episode (E). Osborn waves (arrowheads) were best seen in the inferior and lateral leads around the occurrence of ventricular fibrillation. In contrast to hypothermic patients, the tracing shows sinus tachycardia and short QT intervals.[15]](/index.php/File:Osborne_example.jpg)
EKG's from a case report
![Admission EKG: Sinus bradycardia and giant Osborn wawes [16]](/index.php/File:37-1.AKD.jpg)
![Same patient's post treatment EKG. Faster sinus rhythm with smaller Osborn waves. [16]](/index.php/File:37-1.AKD.discharge.jpg)
References
- ↑ Juvenelle A, Lind J, Wegelius C. Quelques possibilitiés offertes par l'hypothermie générale profonde provoquée: une étude expérimentale chez le chien. Presse Med. 1952;60:973–978.
- ↑ Hersch C. Electrocardiographic changes in head injuries. Circulation. 1961;23:853–860.
- ↑ De Sweit J. Changes simulating hypothermia in the electrocardiogram in subarachnoid hemorrhage. J Electrocardiol. 1972;5:93–95.
- ↑ Hugenholtz PG. Electrocardiographic changes typical for central nervous system disease after right radical neck dissection. Am Heart J. 1967; 74:438–441.
- ↑ Tomaszewski W. Changements électrocardiographiques observés chez un homme mort de froit. Arch Mal Coeur. 1938;31:525–528.
- ↑ Kossmann CE. General cryotherapy: cardiovascular aspects. Bull N Y Acad Med. 1940;16:317.
- ↑ Grosse-Brockhoff F, Schoedel W. Das bild der akuten unterkuhlung im tierexperiment. Arch Exp Path Pharmakol. 1943;201:417.
- ↑ Bigelow WG, Lindsay WK, Greenwood WF. Hypothermia: its possible role in cardiac surgery: investigation of factors governing survival in dogs at low body temperatures. Ann Surg. 1950;132:849–866.
- ↑ Osborn JJ. Experimental hypothermia: Respiratory and blood pH changes in relation to cardiac function. Am J Physiol 1953; 175: 389-398.
- ↑ Maruyama, Mitsunori and Kobayashi, Yoshinori and Kodani, Eitaroh and Hirayama, Yoshiyuki and Atarashi, Hirotsugu and Katoh, Takao and Takano, Teruo. Osborn Waves: History and Significance. Indian Pacing and Electrophysiology Journal 4(1):pp. 33-39 PMID 16943886
- ↑ Juvenelle A, Lind J, Wegelius C. Quelques possibilitiés offertes par l'hypothermie générale profonde provoquée: une étude expérimentale chez le chien. Presse Med. 1952;60:973–978.
- ↑ Hersch C. Electrocardiographic changes in head injuries. Circulation. 1961;23:853–860.
- ↑ Hugenholtz PG. Electrocardiographic changes typical for central nervous system disease after right radical neck dissection. Am Heart J. 1967; 74:438–441.
- ↑ De Sweit J. Changes simulating hypothermia in the electrocardiogram in subarachnoid hemorrhage. J Electrocardiol. 1972;5:93–95.
- ↑ Maruyama M, Kobayashi Y, Kodani E, Hirayama Y, Atarashi H, Katoh T, Takano T. Osborn Waves: History and Significance. Indian Pacing and Electrophysiology Journal, 4(1): 33-39 (2004) PMID 16943886
- ↑ 16.0 16.1 Hoşcan Y, Ozgül M. (2006). "Report of a case with huge Osborn waves". Anadolu Kardiyol Derg. 6: 411–12. PMID 17162309.