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Review Article Volume 18 Issue 4
Electrocardiographic manifestations of hypothermia: pathophysiology, clinical implications, and future directions
Abdülmelik Birgün, Macit Kalçık, Muhammet Cihat Çelik, Mucahit Yetim, Lütfü Bekar, Yusuf Karavelioğlu
Received: September 23, 2025 | Published: October 17, 2025
Citation: Birgün A, Kalçık M, Çelik MC, et al. Electrocardiographic manifestations of hypothermia: pathophysiology, clinical implications, and future directions. J Cardiol Curr Res. 2025;18(4):189-195. DOI: 10.15406/jccr.2025.18.00631
Abstract
Hypothermia, defined as a core body temperature below 35°C, profoundly affects cardiovascular physiology and is associated with characteristic electrocardiographic (ECG) abnormalities. These changes, ranging from sinus bradycardia to life-threatening arrhythmias, provide important diagnostic and prognostic information in both accidental and therapeutic hypothermia. Among these, Osborn waves remain the most recognized hallmark, although other findings including PR, QRS, and QT interval alterations, atrial and ventricular arrhythmias, and conduction blocks are equally relevant for clinical management. This review synthesizes the current evidence on the pathophysiological mechanisms underlying hypothermia-induced ECG changes, their diagnostic and prognostic significance, and their implications for clinical management. In addition, we highlight the challenges in differential diagnosis, particularly the overlap of ECG changes with acute coronary syndromes and other metabolic disorders. Emerging technologies, including artificial intelligence and wearable monitoring, may improve recognition and risk stratification. Future directions emphasize the need for standardized diagnostic criteria, multicenter studies, and exploration of advanced rewarming and anti-arrhythmic strategies. Understanding the spectrum of ECG alterations in hypothermia remains essential for timely recognition, effective treatment, and improved patient outcomes.
Keywords: hypothermia, electrocardiography, osborn wave, arrhythmia, therapeutic hypothermia
©2025 Birgün, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.