Electrocardiographic Manifestations in Three Psychiatric Patients with Hypothermia – Case Report

Case Report

Austin Cardio & Cardiovasc Case Rep. 2016;1(2): 1007.

Electrocardiographic Manifestations in Three Psychiatric Patients with Hypothermia – Case Report

Pelechas E¹*, Tsigaridas N², Kyrama S³, Trogganis E4 and Kardamis Ch5

¹Accident and Emergency Department, Scarborough General Hospital, United Kingdom

²Department of Cardiology, Chatzikosta Hospital, Ioannina, Greece

³Department of Cardiology, General Hospital of Arta, Greece

4Department of Cardiology, General Hospital of Kastoria, Greece

5Department of Cardiology, General Hospital of Corfu, Greece

*Corresponding author: Eleftherios Pelechas, Accident and Emergency Department, Scarborough General Hospital, Scarborough, North Yorkshire, United Kingdom

Received: June 02, 2016; Accepted: June 13, 2016; Published: June 15, 2016


Hypothermia occurs when the core body temperature falls below 35deg;C and, in severe cases, it can lead to electrocardiographic changes. Several conditions which can occur in the psychiatric population increase the risk of hypothermia which can be aggravated by the use of several classes of medications such as antipsychotics, beta-adrenergic antagonists, benzodiazepines and other sedatives. Three psychiatric patients have been admitted for hypothermia and electrocardiographic manifestations (sinus bradycardia, QT prolongation and Osborn waves) which reversed completely after treatment.

Keywords: Hypothermia; Osborn waves; Electrocardiographic changes; Psychiatric patients.


Hypothermia is associated with a spectrum of electrocardiographic changes [1]. The degree of hypothermia leads to various electrocardiographic manifestations [2]. In mild hypothermia (35deg;C - 32deg;C), the Electrocardiogram (ECG) is usually normal but it can rarely show J waves (Osborn waves) [3]. The presence of Osborn waves in inferior and lateral leads, in combination with the appearance of other electrocardiographic manifestations such as increase in PR and QT intervals, increase in QRS complex duration, decrease in amplitude of P and T waves and frequent supraventricular arrhythmias, are noted in moderate hypothermia (32deg;C – 28°C) [4-7]. In severe hypothermia (<28deg;C), additional ECG changes such as J waves in all leads, absence of P waves and frequent ventricular arrhythmias [8-9]. Osborn wave is considered the most specific ECG change in hypothermia [10-12].

Case Presentation

Three psychiatric inmates,within a month (December), have been transferred to the emergency department by ambulance due to low responsiveness (two of them) and coma (the third patient). The medical and drug history of those three patients is presented in (Table 1). Their electrocardiogram showed sinus bradycardia (38bpm – 43bpm), QT prolongation (.52sec - .72sec) and Osborn waves (Figure 1, Figure 2 and Figure 3). There is also a “shivering artifact” on the electrocardiograms of the first and the third patient.