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. 2021 May;5(2):152-154.
doi: 10.5811/cpcem.2021.1.50921.

The "Spiked Helmet" Sign Associated with ST-Elevation Myocardial Infarction: A Case Report

Bruno Minotti  1 , Jörg Scheler  1 , Robert Sieber  1 , Eva Scheler  2
Affiliations

The "Spiked Helmet" Sign Associated with ST-Elevation Myocardial Infarction: A Case Report

Bruno Minotti et al. Clin Pract Cases Emerg Med. 2021 May.

Abstract

Introduction: The "spiked helmet" sign was first described in 2011 by Littmann and Monroe in a case series of eight patients. This sign is characterized by an ST-elevation atypically with the upward shift starting before the onset of the QRS complex. Nowadays the sign is associated with critical non-cardiac illness.

Case report: An 84-year-old man with a history of three-vessel disease presented to the emergency department with intermittent pain in the upper abdomen. The electrocardiogram revealed the "spiked helmet" sign. After ruling out non-cardiac conditions the catherization lab was activated. The coronary angiography revealed an acute occlusion of the right coronary artery, which was balloon-dilated followed by angioplasty. The first 24 hours went uneventfully with resolution of the "spiked helmet" sign. On the second day, however, the patient died suddenly and unexpectedly.

Conclusion: Despite the association with non-cardiac illness, the "spiked helmet" sign can be seen by an acute coronary artery occlusion as an ST-elevation myocardial infarction (STEMI). Reciprocal ST-depression in these cases should raise the suspicion of STEMI.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1
Image 1
Electrocardiographic (lead II) taken from the Monitor System demonstrating the “spiked helmet” sign.
Image 2
Image 2
12-lead electrocardiogram at the presentation demonstrating the “spiked helmet” sign (black arrows) with reciprocal changes (white arrows).
Image 3
Image 3
Post-interventional electrocardiogram with resolution of the “spiked helmet” sign (arrows).
See this image and copyright information in PMC

References

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