Rolfast et al listed common electrocardiographic changes seen in patients undergoing therapeutic hypothermia. The authors are from VU Medical Center in Amsterdam, The Netherlandss.


Patient selection: therapeutic hypothermia (temperature < 35°C), typically mild (32 to 33°C), to reduce neurological damage after cardiac arrest


Common ECG changes:

(1) presence of the Osborn wave (notch in the downstroke of the S wave at the J point)

(2) prolongation of the QTc

(3) atrial fibrillation

(4) ST segment elevation with the absence of reciprocal ST depression (pseudoinfarction)

(5) reduction in heart rate (bradycardia to low normal)



• A patient with true myocardial infarction infarction will show ST depression in reciprocal leads to those showing ST segment elevation.


Hypothermia-related ECG changes typically disappear with rewarming.


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