OSBORN WAVE (J Wave) IN ECG AND ITS INTERPRETATION

OSBORN WAVE IN ECG

1. Osborn Wave (J Wave) Dr.G.VENKATA RAMANA MBBS DNB FAMILY MEDICINE

2. Osborn wave (J wave) P ositive deflection seen at the J point in precordial and true limb leads M ost commonly associated with hypothermia These changes will appear as a reciprocal, negative deflection in aVR and V1 The  J point  in the ECG is the point where the QRS complex joins the ST segment It represents the approximate end of depolarization and the beginning of repolarization as determined by the surface ECG There is an overlap of around 10ms The  J point  may deviate from the baseline in early repolarization, epicardial or endocardial ischemia or injury, pericarditis, RBBB, LBBB, RVH, LVH or digitalis effect

3. J  point in a) normal; b) J point elevation; c) with Osborn wave (J wave); d) J point depression Note: The letter J on the ECG defines 2 totally different and unrelated events The  J point  is a point in time marking the end of the QRS and the onset of the ST segment present on all ECGs The  J wave  is a much less common, slow deflection of uncertain origin originally described in relation to hypothermia

4. Osborn Wave Causes Characteristically seen in hypothermia (typically T < 30C), but they are not pathognomic Causes of non-hypothermic Osborn waves include: Hypercalcemia Acute myocardial ischemia Takotsubo cardiomyopathy Left ventricular hypertrophy due to hypertension Normal variant and early repolarization Neurological insults such as intracranial hypertension, severe head injury and subarachnoid hemorrhage Severe myocarditis Brugada syndrome Le syndrome d’Haïssaguerre (idiopathic VF) Compared to other hypothermia-induced ECG abnormalities (e.g. sinus bradycardia ; supraventricular arrhythmias, QT prolongation and AV block), the Osborn wave is thought to be the most specific

5. Osborn Wave ECG examples Subtle J waves in mild hypothermia [Temp: 32.5°C (90.5°F)] The height of the J wave is roughly proportional to the degree of hypothermia

6. J waves in moderate hypothermia [Temp: 30°C (86°F)]

7. J waves in moderate hypothermia. [Temp: 28°C (82.4°F)]

8. Marked J waves in severe hypothermia [Temp: 26°C (78.8°F)] Note “negative” J waves seen in aVR and V1