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An abnormal electrocardiogram in a hypothermic man
Um eletrocardiograma anormal num homem hipotérmico
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AKI: acute kidney injury; CAV: coronary artery vasculopathy; CKD: chronic kidney disease; CMV: cytomegalovirus; DM: diabetes mellitus; eGFR: estimated glomerular filtration rate; EPO: erythropoietin; HF: heart failure; ISHLT: International Society for Heart and Lung Transplantation; HLA: human leukocyte antigen; KDIGO: Kidney Disease Improving Global Outcomes; MICA: MHC class I-related chain A; U<span class="elsevierStyleInf">Na+</span>: urinary sodium. * includes both pharmacological and non-pharmacological (e.g. smoking and/or alcohol cessation) treatment.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Bruno M.L. Rocha, Catarina Brízido, Gonçalo J.L. Cunha, Christopher Strong, Sara Ranchordas, António Tralhão, Diogo Santos, André Weigert, Carlos M.T. Aguiar, Miguel Sousa-Uva, Miguel Abecasis, Domingos Machado, António Martinho, Miguel Mendes, José P. Neves" "autores" => array:15 [ 0 => array:2 [ "nombre" => "Bruno M.L." 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"apellidos" => "Maciel" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Cardiology Department, Centro Hospitalar Universitário de São João, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Faculdade de Medicina da Universidade do Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Um eletrocardiograma anormal num homem hipotérmico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1609 "Ancho" => 2175 "Tamanyo" => 390951 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Initial electrocardiogram: Osborn waves (arrows), complete atrioventricular block and tremor artifact; (B) electrocardiogram after patient warming: resolution of previous abnormalities.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">An abnormal ECG in a hypothermic man</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 59-year-old man with a history of alcohol abuse was found fallen and unconscious at his home in the winter. He was severely hypothermic (26<span class="elsevierStyleHsp" style=""></span>°C) and with poor peripheral perfusion. The electrocardiogram showed heart rate of 34 bpm, complete atrioventricular block and inferolateral J-wave elevation, suggestive of Osborn waves (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Blood tests showed rhabdomyolysis; toxicology and alcohol screens were negative and brain computed tomography and echocardiogram were normal.</p><p id="par0015" class="elsevierStylePara elsevierViewall">After re-establishment of normothermia with heated intravenous fluids and external warmer, restoration of sinus rhythm and resolution of the Osborn waves was observed (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B).</p><p id="par0020" class="elsevierStylePara elsevierViewall">An elevated J point in hypothermia (Osborn wave) was first described by John Osborn in 1953. Although it has been considered pathognomonic of hypothermia, it may also be present in other conditions, such as electrolyte disturbances or brain injuries. Other typical electrocardiographic abnormalities in hypothermia include prolonged PR/QT/QRS duration, conduction abnormalities and atrial or ventricular arrhythmias.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Considering the similarity of Osborn waves to other forms of J-point elevation, such as myocardial infarction or Brugada syndrome, this may lead to an incorrect diagnosis, especially in the setting of an acute event, which reinforces the importance of knowing this pattern and its cause.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "An abnormal ECG in a hypothermic man" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-12-16" "fechaAceptado" => "2019-12-31" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1609 "Ancho" => 2175 "Tamanyo" => 390951 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Initial electrocardiogram: Osborn waves (arrows), complete atrioventricular block and tremor artifact; (B) electrocardiogram after patient warming: resolution of previous abnormalities.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004000000004/v1_202103300712/S0870255121000755/v1_202103300712/en/main.assets" "Apartado" => array:4 [ "identificador" => "75834" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Imagem em Cardiologia" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004000000004/v1_202103300712/S0870255121000755/v1_202103300712/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255121000755?idApp=UINPBA00004E" ]
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