Extreme Hypothermia



The authors have no funding, financial relationships, or conflicts of interest to disclose.

On a January morning, an 87-year-old woman was found unresponsive in the fields. She had fixed pupils and a respiration rate of about 6 per minute. Rectal temperature was recorded as “< 80°F,” as no thermometer was available to read lower than 80°F. The electrocardiogram demonstrated atrial fibrillation with severe bradycardia and giant Osborn waves measuring up to 25 mm (2.5 mV) in amplitude and 160 ms in duration. In each lead, the axis and amplitude of the Osborn waves followed those of the QRS complexes.1 The patient was successfully rewarmed and survived!

Figure 1.

Electrocardiogram revealing probable atrial fibrillation with a ventricular rate of about 18 per minute. Note that there are only 3 QRS complexes in the entire 10-second recording. Giant J waves or Osborn waves are consistent with severe hypothermia.

Figure 2.

Electrocardiogram the next day shows resolution of atrial fibrillation, normalization of heart rate, trivial terminal notching of the QRS complexes in the inferolateral leads, and artifact.