Bradycardia and tremor are frequently seen with hypothermia. Prominent J point notching- also known as Osborne waves may be seen transiently in hypothermia (Spodick, 2006), and should not be confused with benign early repolarization.

However, there is recent data to suggest its association with fatal arrhythmias, especially if there is STE of > 0.2 mV (Haissaguerre et al., 2008 Myerburg & Castellanos, 2008 Nam, Kim, & Antzelevitch, 2008 Tikkanen, et al., 2009). Early repolarization NISTE was previously thought to be benign in etiology given nearly 5% prevalence in normal population (Klatsky, Oehm, Cooper, Udaltsova, & Armstrong, 2003 Tikkanen et al., 2009). The underlying pathophysiology associated with early repolarization still remains a matter of controversy as some investigators consider it not to be secondary to early repolarization of the ventricle (Mirvis, 1982). Comparison with previous ECGs can serve as a valuable tool. Occasionally, T wave inversions may also be observed in precordial leads which are believed to be associated with juvenile T waves and should not be confused with ischemia. Hence, dynamic nature of ST segment is not always a reliable indicator of ischemia. in many cases and decreases in amplitude or even resolves with hyperventilation and tachycardia.

Non specific ivcd ecg