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.
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http://dx.doi.org/10.11604/pamj.2023.46.58.40438 | DOI Listing |
BMJ Case Rep
October 2024
Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
A woman with a history of chronic idiopathic constipation and remote eating disorders presented to our hospital with generalised weakness and confusion due to severe hypokalaemic rhabdomyolysis. Her initial ECG showed down-sloping ST segment elevations consistent with the 'shark fin' sign, and initial echocardiography was consistent with Takotsubo cardiomyopathy (TCM). She later developed hypotension, hypoxaemia and low central venous oxygen saturation consistent with cardiogenic shock.
View Article and Find Full Text PDFArch Peru Cardiol Cir Cardiovasc
September 2024
Servicio de Medicina Interna, Clínica Guayaquil, Guayaquil, Ecuador. Servicio de Medicina Interna Clínica Guayaquil Guayaquil Ecuador.
The electrocardiographic sign "Spiked Helmet" (SHS) has been described in critically ill patients and is associated with a high risk of death. We present the case of a young individual with Marfan syndrome, who developed a Takotsubo cardiomyopathy and the electrocardiographic manifestation of SHS, 72 hours after the postoperative period for a ruptured abdominal aorta aneurysm. In this case, the factors that may justify the presentation of this electrocardiographic pattern are the thoraco-abdominal surgical intervention and Takotsubo cardiomyopathy, which together activated the sympathetic system, triggering the clinical-electrocardiographic manifestation.
View Article and Find Full Text PDFRev Cardiovasc Med
September 2023
Department of Cardiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, 264000 Yantai, Shandong, China.
The spiked helmet sign (SHS) is a rare electrocardiographic marker associated with an increased risk of lethal ventricular tachyarrhythmias and sudden cardiac death. To our knowledge, this is the first study aimed at reviewing recent research progress on this electrocardiogram (ECG) pattern to summarize its electrophysiological mechanisms, epidemiological features, clinical characteristics, and clinical significance. SHS formation is attributed to sympathetic hyperactivity, which mediates increased dispersion of ventricular repolarization, leading to marked QT prolongation and macroscopic T-wave alternans.
View Article and Find Full Text PDFJ Electrocardiol
June 2024
Division of Cardiology, UCSF School of Medicine and the Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
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.
View Article and Find Full Text PDFPan Afr Med J
January 2024
Cardiology Department, Sahloul University Hospital, Faculty of Medicine Ibn El Jazzar of Sousse, University of Sousse, Sousse, Tunisia.
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.
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