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The electrocardiogram in hypothermia.
C A Graham1, G W McNaughton, J P Wyatt
1Southern General Hospital, Glasgow, Scotland, United Kingdom. ColinGraham@bigfoot.com
Wilderness & Environmental Medicine
|January 5, 2002
Summary
Electrocardiograms (ECGs) in urban hypothermia reveal frequent abnormalities. While J waves are not prognostic, the absence of shivering may indicate a poorer outcome, warranting further investigation into hypothermia
Area of Science:
- Cardiology
- Emergency Medicine
- Environmental Health
Background:
- Hypothermia significantly impacts cardiac function and electrocardiogram (ECG) findings.
- Accidental hypothermia in urban settings presents unique challenges for diagnosis and management.
Purpose of the Study:
- To determine the incidence of specific cardiac dysrhythmias, J waves, and conduction abnormalities in patients with accidental urban hypothermia.
- To assess the prognostic value of ECG findings, including J waves and shivering artifact, in relation to survival.
Main Methods:
- A prospective, multicenter study involving the analysis of 73 ECGs from patients with accidental urban hypothermia.
- Independent ECG analysis by two authors, categorizing rhythms into six predefined groups.
- Statistical analysis to evaluate associations between ECG findings, shivering artifact, and survival.
Main Results:
- Normal sinus rhythm was observed in 41% of patients; overall mortality was 36%.
- J waves were present in both survivors and non-survivors (36-38%), showing no prognostic value.
- Shivering artifact was more common in survivors (66%) and associated with survival in severe hypothermia (P = .047).
- Atrial fibrillation and junctional bradycardia were linked to increased mortality.
Conclusions:
- The ECG is frequently abnormal in patients with accidental hypothermia.
- J waves are not an independent prognostic indicator in hypothermia.
- The inability to shiver might be associated with a worse prognosis, meriting further research.