ICU/EKG: Hypothermia & EKG changes ...Osborn Wave

(Extract from "Principles of Clinical Electrocardiography". Mervin J. Goldman. 11th ed. 1982 p. 291)

Hypothermia induces EKG changes:
1) Sinus bradycardia
2) Junctional rhythm
3) Prolongation of QTc

With extreme degrees of cooling,...
1) Intraventricular conduction delay - causing notching of terminal portion of QRS (Osborn wave) followed by ST elevation
2) ST elevation
3) V. fib (when rectal temp falls below 28 degree C.

Other references:
1) Kelly FE, Nolan JP. The effects of mild induced hypothermia on the myocardium: A systematic review. Anesthesia 2010 Feb 11 [Epub ahead of print]
2) Fink EL, Kochanek PM, Clark RS, Bell MJ. How I cool children in neurocritical care. Neurocrit care 2010 Feb 10 [Epub ahead of print]
3) Khan JN, Prasad N, Glancy JM. QTc prolongation during therapeutic hypothermia: are we giving it the attention it deserves? Europace 2010 Feb;12:266-70. [Epub 2009 Nov 30]
4) Fink EL, Clark RS, Kochanek PM, Bell MJ, Watson RS. A tertiary care center's experience with therapeutic hypothermia after pediatric cardiac arrest. Pediatr Crit Care Med 2010 Jan;11:66-74.
5) Tiainen M, Parikka HA, Makijarvi MA, Takkunen OS, Sarna SJ, Roine RO. Arrhythmias and heart rate variability during and after therapeutic hypothermia for cardiac arrest. Crit Care Med 2009 Feb;37:403-9

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