Spiked helmet sign: An under-recognized electrocardiogram finding in critically ill patients
Ajay Agarwal, Timothy G. Janz, Naga V. Garikipati
Critical illness, electrocardiogram, mortality, myocardial infarction
Citation Information :
Agarwal A, Janz TG, Garikipati NV. Spiked helmet sign: An under-recognized electrocardiogram finding in critically ill patients. Indian J Crit Care Med 2014; 18 (4):238-240.
CC BY-ND 3.0
Copyright © 2014; Jaypee Brothers Medical Publishers (P) Ltd.
A 77-year-old male patient presented with rhabdomyolysis. He developed progressive respiratory failure and acute respiratory distress syndrome during his hospital stay requiring mechanical ventilation. An electrocardiogram during mechanical ventilation showed findings suggestive of ST elevation myocardial infarction. Closer review showed dome and spike findings that have been likened to a \"spiked helmet.\" This finding has been associated with significant mortality. We discuss this under-recognized finding and the potential contributing mechanisms.
Rennyson SL, Hunt J, Haley MW, Norton HJ, Littmann L. Electrocardiographic ST-segment elevation myocardial infarction in critically ill patients: An observational cohort analysis. Crit Care Med 2010;38:2304-9.
Littmann L, Monroe MH. The "spiked helmet" sign: A new electrocardiographic marker of critical illness and high risk of death. Mayo Clin Proc 2011;86:1245-6.
Tomcsányi J, Frész T, Bózsik B. ST elevation anterior "spiked helmet" sign. Mayo Clin Proc 2012;87:309.
Chase C, Brady WJ. Artifactual electrocardiographic change mimicking clinical abnormality on the ECG. Am J Emerg Med 2000;18:312-6.
Hall BW, Knight BP. An abnormal electrocardiogram in a young man: What is the etiology? Pacing Clin Electrophysiol 2002;25:1510-2.
Frye RL, Braunwald E. Bilateral diaphragmatic contraction synchronous with cardiac systole. N Engl J Med 1960;263:775-8.
Sjoerdsma A, Gaynor WB. Contraction of left leaf of diaphragm coincident with cardiac systole. J Am Med Assoc 1954;154:987-9.
Brearley WD Jr, Taylor L 3rd, Haley MW, Littmann L. Pneumomediastinum mimicking acute ST-segment elevation myocardial infarction. Int J Cardiol 2007;117:e73-5.
Tennant FS Jr, Weiss MM, Leight L. Electrocardiographic changes following diaphragmatic inspiration. Angiology 1968;19:499-505.