A 57-year-old man was admitted after an out-of-hospital cardiac arrest. He received bystander basic life support followed by prolonged resuscitation at the emergency department and was subsequently transferred to the intensive care unit under mechanical ventilation. Therapeutic cooling was introduced, and his core temperature was monitored with a rectal thermometer. As a result of false high temperature readings secondary to sensor malfunction, cooling procedures were intensified and severe ECG changes appeared on the cardiac monitor. The rectal thermometer was replaced, and a core temperature of 27°C was recorded. ECG demonstrated giant Osborn waves that progressively diminished once rewarming was initiated (Figure).Osborn or J wave is a common ECG finding in hypothermia, appearing as a slow upright deflection between the end of the QRS complex and the early portion of the ST segment. Hypercalcemia, vasospastic angina, Brugada syndrome, and subarachnoid hemorrhage can demonstrate a similar ECG pattern. DisclosuresNone. Figure. ECGs demonstrating progressiveOsborn wave resolution after patient rewarming.

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We appreciate Drs Joynt and Edelman's thoughtful comments on our recent publication. 1 They suggested that the presence of Osborn waves on ECGs of patients undergoing therapeutic hypothermia depends not only on core body temperature, but also on abnormalities of blood pH. After resuscitation, our patient was initially acidotic, and this was driven mainly by increased lactic acid levels. However, once therapeutic hypothermia was introduced, pH had already normalized (7.37) and remained within normal limits (7.35) even when profound hypothermia (80.6°F) was noted. In a study published in 1959 by Emslie-Smith et al, 2 no correlation was found between blood pH and the development of Osborn J waves in hypothermic dogs. Moreover, the deflection was also recorded in dogs that became alkalotic after hyperventilation. More recently, Brunson et al 3 found that J waves appeared on the ECG of hypothermic dogs even when pH was within the physiological range. Although low blood pH levels are a common finding in postresuscitated patients undergoing therapeutic hypothermia, it remains unclear whether they affect the appearance of Osborn waves. DisclosuresNone. wave appearance on the electrocardiogram in relation to potassium transfer and myocardial metabolism during hypothermia. Antonios

Various electrocardiography (ECG) abnormalities have been reported in patients who present with pulmonary embolism (PE). Severe sepsis is also associated with ECG changes that may mimic ST elevation myocardial infarction. We report a case of an elderly patient with PE and septic shock associated with striking ECG changes.