- •Timely recognition of the spiked helmet sign and its role in preventing unnecessary coronary imaging.
- •Identification of lung recruitment ventilation with high pressures in critically ill patients as one of the potential causes of SHS.
- •To understand the pathophysiologic mechanisms associated with the spiked helmet sign.
The 'spiked helmet sign' (SHS) is an electrocardiographic finding associated with critical illness and a high risk of death; It is likened to ST-elevation, leading to harmful coronary imaging despite lack of apparent myocardial infarction.
We describe the case of SHS secondary to high ventilation pressures in the setting of Acute Respiratory Distress Syndrome (ARDS) in a critically ill patient who subsequently developed barotrauma.
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- Electrocardiographic ST-segment elevation myocardial infarction in critically ill patients: an observational cohort analysis*.Crit Care Med. 2010; 38: 2304-2309https://doi.org/10.1097/CCM.0b013e3181fa02cd
- Spiked helmet sign: an under-recognized electrocardiogram finding in critically ill patients.Indian J Crit Care Med. 2014; 18: 238-240https://doi.org/10.4103/0972-5229.130576
- The "Spiked Helmet" Sign: a New Electrocardiographic Marker of Critical Illness and High Risk of Death.Mayo Clin Proc. 2011; 86: 1245-1246https://doi.org/10.4065/mcp.2011.0647
- Spiked Helmet" sign - A potential relationship to Takotsubo cardiomyopathy.Am J Emerg Med. 2018; 36: 345.e5-345.e7https://doi.org/10.1016/j.ajem.2017.11.041
- Helmet Sign on ECG: a Rare Indicator of Poor Prognosis in Critically Ill Patients.Am J Med Case Rep. 2019; 7: 260-263https://doi.org/10.12691/ajmcr-7-10-9
- Spiked helmet pattern ST elevation in subarachnoid hemorrhage.J Electrocardiol. 2019; 52: 96-98https://doi.org/10.1016/j.jelectrocard.2018.11.016
- Is the spiked helmet sign the manifestation of long QT syndrome?.J Electrocardiol. 2019; 55: 16-19https://doi.org/10.1016/j.jelectrocard.2019.04.011
- Two forms of the spiked helmet sign are caused by two separate mechanisms.J Electrocardiol. 2019; (S0022073619305060)
- Electrocardiographic characteristics and associated outcomes in patients with Takotsubo Syndrome. Insights from the RETAKO Registry.Curr Probl Cardiol. 2021; 46100841https://doi.org/10.1016/j.cpcardiol.2021.100841
- Traumatic Subarachnoid Hemorrhage and QTc Prolongation.J Neurosurg Anesthesiol. 2022; (Accessed April 28)
- The electrocardiographic spiked helmet sign: is it real, artifact, or optical illusion?.J Electrocardiol. 2019; 55: 152-154https://doi.org/10.1016/j.jelectrocard.2019.06.002
- Spiked helmet electrocardiographic sign in a patient with a diagnosis of thoracoabdominal aortic dissection.JACC Case Rep. 2020; 2: 2353https://doi.org/10.1016/j.jaccas.2020.09.026
- Tombstone ST elevations: … not necessarily a harbinger of doom!.Am J Med. 2013; 126: e5-e6https://doi.org/10.1016/j.amjmed.2012.05.019
- Spiked helmet sign after percutaneous Left stellate ganglion ablation in a patient with long QT syndrome.J Electrocardiol. 2017; 50: 944-946https://doi.org/10.1016/j.jelectrocard.2017.06.016
Published online: October 13, 2022
Accepted: September 30, 2022
Received in revised form: August 22, 2022
Received: June 27, 2022
Published by Elsevier Inc.