Spiked Helmet Sign

Electrocardiographic spiked-helmet sign in critical non-cardiac illness

“…The SHS, named after the German Pickelhaube , is a relatively new electrocardiographic finding characterised by apparent ST-segment deviation (generally elevation), with an upward shift preceding the QRS complex, thus conforming to a spike-and-dome pattern 2. Distinct from the ‘ Pickelhaube sign’ seen with mitral annular disjunction on transthoracic echocardiography, SHS is an electrocardiographic finding of pseudo-ST-segment elevation in critically ill patients with high risk of mortality unrelated to myocardial ischaemia/infarction, resolving spontaneously as clinical conditions improve 6–10. While the underlying mechanism remains to be elucidated, several hypotheses have been postulated, a discussion of them follows.…”

A cardiac arrest on a spiked helmet electrocardiographic sign in anterior leads in a patient with a diagnosis of acute myocardial infarction: A case report

“…Occasionally, certain pathological disorders can cause repetitive diaphragm contraction that is in concert with the cardiac cycle [ 6 , 7 ]. Various acute illnesses are linked to particular localizations of the spiked helmet sign in the 12-lead ECG, such as acute coronary syndrome [ 8 ], aortic dissection [ 9 ], and subarachnoid hemorrhage [ 5 ].…”

The “Spiked Helmet Sign”, a Mimic of ST-Elevation Myocardial Infarction in Post-Nephrectomy Ileus

“…Although the mechanism of SHS is not well understood, intra-thoracic or intra-abdominal pressure resulting in pulsatile epidermal stretch [1] and marked prolongation of the QT interval [10] are both postulated mechanisms of SHS. In all reported cases, SHS changes on ECG resolve upon treatment of the underlying pathology [2][3][4][5][6][7][8][9].…”

“…SHS is described as a marker of non-cardiac critical disease [1], with intra-abdominal and intra-thoracic pathology with ST changes found in inferior and precordial ECG, respectively [2][3][4][5][6][7][8][9]. This example shows precordial SHS with an intra-abdominal rather than intra-thoracic cause.…”

“…This example shows precordial SHS with an intra-abdominal rather than intra-thoracic cause. Gastric distension, ileus, small bowel obstruction, and bowel perforation are all intra-abdominal pathologies that have been linked to SHS [2][3][4][5][6][7]. Intra-thoracic pathologies associated with SHS include pneumothorax and aortic dissection [7][8][9].…”