We report an 83-year-old male patient who was found by the emergency medical service team with loss of consciousness with Glasgow Coma Scale (GCS) at 12), bradycardia,  hypotension, purpuric spots. Electrocardiogram showed an irregular bradyarrhythmia at 40/min with atrial fibrillation, prominent accessory waves, continuous and concordant with the QRS complex in all leads. A delayed ventricular conduction was noted with prolongation of QRS complex at 240 ms, and QT interval was 520 ms. the ECG demonstrate also a diffuse ST segment depression. Hypothermia was not suspected as the cause of the ECG’s abnormalities. EMS performed a fluid challenge and the patient was transferred to the Emergency department of Sahloul. He’s clinical course was rapidly complicated by a ventricular fibrillation and death. 

Key words: hypothermia, J wave, ventricular fibrillation