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A Distinctive Electrocardiographic Pattern: Unveiling the Spiked Helmet Sign
Mascha Bosnjak1, Thomas Nottingham2, Gabriela Strey2
1School of Medicine, University of Queensland, Brisbane, Australia.
JACC. Case Reports
|May 30, 2025
Summary
The spiked helmet sign (SHS) on electrocardiogram (ECG) can indicate gastric dilatation, not heart issues. Recognizing this link is crucial for correct diagnosis and treatment of acutely ill patients.
Area of Science:
- Cardiology
- Gastroenterology
- Medical Diagnostics
Background:
- The spiked helmet sign (SHS) is a rare electrocardiogram (ECG) finding characterized by ST-segment elevation.
- This distinctive ECG pattern is often not associated with cardiac conditions, despite its appearance.
Observation:
- A case of gastric dilatation presenting with the spiked helmet sign (SHS) on ECG is reported.
- This observation highlights an unusual association between a gastrointestinal condition and a specific ECG manifestation.
Findings:
- SHS is identified as an uncommon manifestation of gastric dilatation, potentially caused by vagal stimulation from gastric distention.
- This vagal stimulation can affect cardiac repolarization, leading to the observed ECG changes.
- Differential diagnoses for ST-segment elevation include left bundle branch block, early repolarization, pericarditis, and TakoTsubo cardiomyopathy.
Implications:
- Accurate interpretation of ECG findings, including SHS, requires considering the patient's overall clinical context and other diagnostic results.
- Misinterpretation of SHS can lead to inappropriate management strategies.
- Recognizing gastric dilatation as a potential cause of SHS is vital for timely and correct patient care.
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