An 89-year-old man with hypertension, diabetes and coronary artery disease suffered cardiac arrest at home. When the Emergency Medical Service arrived he was pulseless, but shortly afterwards there was spontaneous return of circulation. He is admitted to ICU and is vigorously treated.

• Marked sinus bradycardia (49/min) with first degree AV block
• Left axis deviation
• Right bundle branch block
• Anterior myocardial infarction, age undetermined
• Prominent J wave (Osborn wave), marked by the arrows, suggestive of hypothermia  

See review article on the Web: Mitsunori Maruyama et Al.: Osborn Waves: History and significance – Indian Pacing Electrophysiol. J. 2004; 4 (1) 33-39

Upon arrival at Hospital Emergency the patient was confused and disorientated. He opened his eyes spontaneously and responded to painful stimuli. He was transferred to the ICU and was treated with hypothermia.

When this ECG was recorded, his body temperature was 30.4 C. A J wave (Osborn wave) is clearly seen in I, aVL and V1 to V5. Q waves are present in V2 to V5. The patient had a history of a previous anterior infarction.

The patient is treated with hypothermia for 24 hours and is then warmed up:

• (one motion artifact in leads II and III)
• Sinus rhythm with sinus arrhythmia and one supraventricular premature complex
• Right bundle branch block
• Left anterior fascicular block
• Anterior myocardial infarction, age undetermined
• The J wave (Osborn wave) is no longer present