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