ABSTRACT
A 69-year-old woman was admitted after a cardiac arrest. She developed status epilepticus and was later found to have variable morphologies of a "spiked helmet sign" (SHS) on ECGs in the setting of prolonged QT interval, raising the question of whether this sign is a manifestation of QT prolongation.
Subject(s)
Electrocardiography , Long QT Syndrome , Humans , Female , Aged , Long QT Syndrome/diagnosis , Long QT Syndrome/physiopathology , Diagnosis, Differential , Status Epilepticus/etiology , Status Epilepticus/diagnosis , Heart Arrest/etiologyABSTRACT
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.
Subject(s)
Barotrauma , Myocardial Infarction , Humans , Electrocardiography , Head Protective Devices , Arrhythmias, Cardiac , Critical Illness , Barotrauma/complications , Barotrauma/diagnosisABSTRACT
Early diagnosis of the spiked helmet sign is challenging. This ST-elevation myocardial infarction mimic was first described in 2011 by Littmann and colleagues and was linked to severe non-coronary pathologies, with a high risk of mortality. We present a case of a 60-year-old female patient who developed severe erysipelas with sepsis associated with severe hypokalemia. She had a spiked helmet sign on her routine electrocardiogram at hospital admission. We performed a coronary angiogram that showed no culprit artery. She developed afterward an ischemic stroke. Through intensive management of the patient's sepsis and electrolyte disturbance, she had a favorable outcome.
Subject(s)
Erysipelas , ST Elevation Myocardial Infarction , Sepsis , Humans , Female , Middle Aged , Head Protective Devices , ST Elevation Myocardial Infarction/diagnosis , Electrocardiography , Sepsis/diagnosisABSTRACT
In patients with critical heart disease, such as acute coronary syndrome, aortic dissection, and other diseases, ST-segment elevation is a relatively common finding on the electrocardiogram (ECG). There are various other well-known signs described in heart diseases, such as negative T waves and q waves of necrosis. The "spiked helmet sign" is a novel electrocardiographic sign described first in 2011, whose pathophysiology and clinical applicability remain uncertain at this time. Herein we report the case of a cardiac arrest in a patient who developed the "spiked helmet electrocardiographic sign" concomitantly with acute myocardial infarction, leading to the patient's death from ventricular fibrillation. This case report aims to discuss the "spiked helmet electrocardiographic sign", and to detail the prognostic and diagnostic interest of this sign, wich seems to be different from a standard ST segment elevation.
ABSTRACT
The spiked-helmet sign is a marker for high mortality in critical patients. It is characterised as a dome-shaped ST-segment elevation accompanied by an upward shift of the baseline before the onset of the QRS complex. We present two patients with the spiked-helmet sign on electrocardiogram. Patient A showed a potential relationship between the spiked-helmet sign and hyper-osmolar hyper-glycaemic state, whereas patient B had clinically suspected viral myocarditis.
Subject(s)
Electrocardiography , Heart Injuries , Arrhythmias, Cardiac , Biomarkers , Head Protective Devices , HumansABSTRACT
Spiked helmet sign is a novel electrocardiogram marker that reflects a poor prognosis, and may mimic myocardial infarction, especially in patients with an acute alteration of mental status or out-of-hospital cardiac arrest. In cases where a spiked helmet sign is missed, there may be a delay in surgical intervention for the underlying conditions because of unnecessary cardiac catheterization. In addition, antiplatelet agents for acute coronary syndrome in such cases can lead to catastrophic complications. Therefore, early recognition of spiked helmet sign is useful for timely correction of the underlying disease and prevention of poor outcomes. Herein, we describe a rare case of a patient with internal bleeding and subarachnoid hemorrhage presenting with spiked helmet sign on an electrocardiogram.
Subject(s)
Acute Coronary Syndrome , Myocardial Infarction , Arrhythmias, Cardiac , Electrocardiography , Head Protective Devices , HumansABSTRACT
RESUMEN En la evaluación de pacientes con eventos abdominales o torácicos agudos se ha encontrado una elevación del segmento ST similar a la que se presenta en el infarto agudo de miocardio. Este nuevo patrón se caracteriza por presentar elevación de la línea isoeléctrica precedente a los QRS, seguido de una onda R picuda y supradesnivel convexo del segmento ST que se denomina, debido a su semejanza gráfica, signo de «spiked helmet» (casco prusiano), lo cual -traducido al español- significa casco con púas. Se presenta el caso de una paciente de 56 años de edad, con antecedentes de hipertensión arterial, a quien se le realizó una cirugía abdominal urgente y presentó, en el electrocardiograma, un supradesnivel del segmento ST > 1 mm en DII, DIII y aVF, con ondas R picudas, que desaparecieron a las 6 horas, sin que se demostrara enfermedad cardíaca asociada.
ABSTRACT An ST-segment elevation similar to that in acute myocardial infarction has been found during the assessment of patients with acute abdominal or thoracic events. In this relatively new electrocardiographic pattern, the elevation of the isoelectric line precedes the QRS, followed by a sharp R wave and convex ST-segment elevation known as the "spiked helmet" sign because of its resemblance to the Prussian military helmet, the Pickelhaube. We present the case of a 56-year-old female patient with a history of high blood pressure who underwent emergency abdominal surgery. The electrocardiogram showed ST-segment elevation > 1 mm in DII, DIII and aVF, with sharp R waves that disappeared at 6 hours. No associated cardiac disease was identified.
ABSTRACT
Összefoglaló. Egy 47 éves nobeteg tranziens ST-eleváció miatt került felvételre és coronarographiára. A tranziens ST-elevációnak véleményezett elektrokardiogram poroszsisak-jelnek felelt meg, amelyet egy EKG-mutermék okozott. Habár a poroszsisak-jelnek számtalan, nem coronariaeredetu oka ismert, mutermék okozta poroszsisak-jelet még nem ismertettek. Fontos a felismerése a felesleges diagnosztikai és terápiás beavatkozások elkerülése céljából. Orv Hetil. 2021; 162(34): 1383-1385. Summary. A 47-year-old female patient was admitted for coronary angiography due to transient ST elevation. The electrocardiogram rated for transient ST elevation corresponded to a spiked helmet sign caused by an ECG artifact. Although a number of non-coronary causes of the spiked helmet sign are known, not one caused by a computer artifact has been reported yet. It is important to recognize it to avoid unnecessary diagnostic and therapeutic interventions. Orv Hetil. 2021; 162(34): 1383-1385.
Subject(s)
Acute Coronary Syndrome , Acute Coronary Syndrome/diagnosis , Artifacts , Coronary Angiography , Electrocardiography , Female , Head Protective Devices , Humans , Middle AgedABSTRACT
We present a case of a patient who suffered subarachnoid haemorrhage (SAH), complicated by takotsubo syndrome, paroxysmal atrial fibrillation and ECG repolarisation abnormality, compatible with Brugada phenocopy. The early repolarisation morphology showed a paradox association with the cardiac cycle length; a relationship not yet documented in SAH. Our observation also sheds light on the genesis of the "spiked helmet" ECG sign.
Subject(s)
Atrial Fibrillation , Subarachnoid Hemorrhage , Takotsubo Cardiomyopathy , Electrocardiography , Humans , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/diagnosis , Tachycardia , Takotsubo Cardiomyopathy/complications , Takotsubo Cardiomyopathy/diagnosisABSTRACT
Electrocardiographic (ECG) artifact, a common nuisance, has a wide range of manifestations with varying clinical significance. Beyond loose leads, motion artifacts and broken wires, artifact can also be caused by external and implanted devices as well as by physiologic signals. ECG artifact can mimic a variety of serious clinical conditions and arrhythmias such as acute myocardial infarction and ventricular tachycardia. The purpose of this review is to provide a structured approach to the recognition of the different forms of ECG artifact and to offer simple and practical steps to avoid misdiagnoses caused by artifact. Special attention is given to artifact whose presence can actually aid in the diagnosis of important and sometimes critical clinical conditions.
Subject(s)
Artifacts , Tachycardia, Ventricular , Arrhythmias, Cardiac/diagnosis , Diagnostic Errors , Electrocardiography , Humans , Tachycardia, Ventricular/diagnosisABSTRACT
We report the case of a patient who developed the spiked helmet electrocardiographic (ECG) sign concomitantly with a thoracoabdominal aortic dissection resulting in ischemic functional ileum with gastric distention. Prompt identification of this ECG sign could prevent unnecessary emergent percutaneous cardiac catheterization procedures. (Level of Difficulty: Beginner.).
Subject(s)
Brugada Syndrome , Myocardial Infarction , Optical Illusions , Artifacts , Electrocardiography , Head Protective Devices , HumansABSTRACT
We present the case of a patient with Takotsubo syndrome developing simultaneous inferior, anterior spiked helmet sign (SHS) and macroscopic T-wave alternans (TWA) leading to torsade de pointes ventricular tachycardia (TdP VT). Based on our observations we propose that the SHS is a type of manifestation of critically prolonged QT(U).
Subject(s)
Long QT Syndrome , Torsades de Pointes , Arrhythmias, Cardiac , Electrocardiography , Humans , Long QT Syndrome/diagnosisABSTRACT
Subarachnoid hemorrhage (SAH) is occasionally associated with the electrocardiographic (ECG) pattern of ST-segment elevation myocardial infarction (STEMI). Missing the true clinical diagnosis can result in inappropriate and harmful interventions. We report the case of a 40-year-old female who was found down. The ECG was diagnostic for acute lateral STEMI. Further analysis of the ECG showed marked prolongation of the QT interval and the "spiked helmet sign" (SHS). The patient was ruled out for myocardial infarction and a head CT demonstrated a massive SAH with acute hemorrhage into the ventricles. Review of the literature and of our own ECG files revealed additional cases where severe acute central nervous system (CNS) conditions were associated with the SHS.
