A Distinctive Electrocardiographic Pattern: Unveiling the Spiked Helmet Sign.

BACKGROUND

The spiked helmet sign (SHS) on electrocardiogram (ECG) is a rare and distinctive pattern of ST-segment elevation resembling a traditional spiked German military helmet. Counterintuitively, it is typically not associated with cardiac conditions.

CASE SUMMARY

We report a case of gastric dilatation with this ECG phenomenon.

DISCUSSION

SHS is an uncommon ST-segment elevation manifestation of gastric dilatation likely due to gastric distention-induced vagal stimulation affecting cardiac repolarization. ST-segment elevations in the ECGs of acutely ill patients can have different causes, eg, left bundle branch block, early repolarization, pericarditis, TakoTsubo cardiomyopathy, and gastric dilatation. Recognition of the underlying cause is crucial to accurate diagnosis and appropriate management.

TAKE-HOME MESSAGES: ECG changes must be interpreted in the context of the patients' condition and other investigation results such as troponin, electrolytes, and imaging. ECG findings including SHS can be easily misinterpreted and prompt inappropriate management.