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(Stroke. 2001;32:1692-a.)
© 2001 American Heart Association, Inc.

Letters to the Editor

Should Stroke Caregivers Recognize the J Wave (Osborn Wave)?

Josef G. Heckmann, MD; Christoph J.G. Lang, MD, PhD Bernhard Neundörfer, MD, PhD

Department of Neurology

Susanne Ropers, MD Werner Moshage, MD, PhD

Department of Cardiology, University of Erlangen-Nuremberg, Nuremberg, Germany

To the Editor:

It is essential for stroke caregivers to be familiar with the basics of electrocardiography. A number of disorders of the brain are caused by abnormalities of cardiac rhythm: tachyarrhythmia absoluta, Morgagni-Adams-Stokes syncope, Romano-Ward syndrome, and ST changes following stroke or due to electrolyte disorders,¹ to name a few. Only rarely is a J wave or Osborn wave seen in clinical practice, although this wave has been observed in the ECGs of animals and humans for more than 4 decades.² The J wave is a deflection that appears in the ECG as a dome or hump configuration.³ It occurs most often in hypothermia⁴ but is also seen in normothermia, electrolyte disorders, brain injury, or subarachnoidal hemorrhage.^{5 6 7} In this letter we wish to demonstrate a clear J wave in association with severe hypothermia.

A hiker found a 70-year-old male comatose at his fishing pool on a cold winter day. The summoned paramedic intubated the patient and ventilated him mechanically. In the emergency room, his first ECG demonstrated a prominent J wave (Figure). His body temperature was 25.2°C. The blood gas analysis revealed a pH of 7.13 (normal 7.35 to 7.45), with a base excess of -16.4 mmol/L (normal -2 to +3 mmol/L). Potassium was slightly diminished (3.1 mmol/L; normal 3.5 to 5.0 mmol/L). A cranial CT scan revealed severe intracerebral hemorrhage as the underlying cause of coma.

View larger version (149K): [in this window] [in a new window]   Figure 1. Electrocardiography (12-lead) showing prominent J wave in leads I (arrow), II, V2, V3, V4 (arrow), and V5.

The patient was gradually . . . [Full Text of this Article]