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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
PubMed
Summary
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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.

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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.