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

Bruno Minotti, Jörg Scheler, Robert Sieber & Eva Scheler

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.
   
keywords piked helmet sign; upper abdomen pain; chest pain; STEMI; emergency department; case report
   
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;.
   
type journal paper/review (English)
date of publishing 10-5-2021
journal title Clinical Practice and Cases in Emergency Medicine (WestJEM)
DOI 10.5811/cpcem.2021.1.50921
link https://escholarship.org/uc/item/71s3v2fc
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