J wave

Electrocardiographic finding associated with hypothermia and other conditions

J wave

The J wave, also known as the Osborn wave, is a distinctive deflection seen on the electrocardiogram (ECG) that occurs at the junction between the QRS complex and the ST segment. It is characterized by a positive deflection immediately following the QRS complex, often best observed in the inferior and lateral leads of the ECG.

Osborn wave example

History

The J wave was first described by John J. Osborn in 1953, who identified it as a marker of hypothermia. Since then, it has been associated with various other clinical conditions, including hypercalcemia, brain injury, and early repolarization syndrome.

Pathophysiology

The exact mechanism of the J wave is not fully understood, but it is believed to be related to the differential repolarization of the epicardial and endocardial layers of the heart. In hypothermia, the J wave is thought to result from altered ion channel function at lower body temperatures, particularly affecting the sodium and calcium channels.

Clinical Significance

The presence of J waves on an ECG can be a critical diagnostic clue in the context of hypothermia, where they are often referred to as "Osborn waves." In this setting, they are typically seen when the core body temperature drops below 32°C (89.6°F). However, J waves can also appear in normothermic patients with other conditions, such as Brugada syndrome, where they may indicate an increased risk of ventricular fibrillation and sudden cardiac death.

Associated Conditions

• Hypothermia: The classic association, where J waves are most prominently observed.
• Hypercalcemia: Elevated calcium levels can lead to the appearance of J waves.
• Neurological injury: Conditions such as subarachnoid hemorrhage can also produce J waves.
• Brugada syndrome: A genetic disorder that affects cardiac sodium channels, leading to characteristic ECG changes including J waves.
• Early repolarization syndrome: A benign condition that can mimic the appearance of J waves on an ECG.

Diagnosis

The diagnosis of a J wave is made through careful analysis of the ECG. It is important to consider the clinical context, as the presence of J waves can have different implications depending on the underlying condition. In hypothermia, the J wave is a key diagnostic feature, while in other conditions, it may warrant further investigation to assess the risk of arrhythmias.

ECG showing hypothermia with J waves

Management

Management of patients with J waves depends on the underlying cause. In hypothermia, rewarming the patient is the primary treatment, which often leads to the resolution of J waves. In cases where J waves are associated with arrhythmogenic conditions like Brugada syndrome, specific antiarrhythmic therapies and lifestyle modifications may be necessary.

Prognosis

The prognosis for patients with J waves varies widely based on the underlying condition. In hypothermia, prompt rewarming can lead to a good outcome, while in conditions like Brugada syndrome, the risk of sudden cardiac death may necessitate more aggressive management strategies.

Related pages

• Electrocardiography
• Hypothermia
• Brugada syndrome
• Early repolarization