Publication

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

Journal Paper/Review - May 10, 2021

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Keywords
piked helmet sign; upper abdomen pain; chest pain; STEMI; emergency department; case report
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Citation
Minotti B, Scheler J, Sieber R, Scheler E. The “Spiked Helmet” Sign Associated with ST-Elevation Myocardial Infarction: A Case Report. Clinical Practice and Cases in Emergency Medicine (WestJEM) 2021; 5:152-154.
Type
Journal Paper/Review (English)
Journal
Clinical Practice and Cases in Emergency Medicine (WestJEM) 2021; 5
Publication Date
May 10, 2021
Pages
152-154
Brief description/objective

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.