Volcanic mountain sign: A variant of the spiked helmet sign

The spiked helmet sign is an electrocardiographic (ECG) abnormality characterized by a dome-and-spike pattern where upright QRS complexes are preceded by upslope and followed by downslope of the ECG baseline. Numerous studies have demonstrated that the spiked helmet sign is a marker of critical, usually noncardiac illness and a high risk of death. In this report we describe an ECG abnormality we termed volcanic mountain sign that appears to be a variant of the spiked helmet sign. In the volcanic mountain sign, a negative QRS complex mimicking the central vent of a volcano starts from the top of a mountain-shaped dome or from the bottom of a crater-like depression. The volcanic mountain sign too is seen in patients with acute, severe and occasionally lethal noncardiac illnesses. Resolution of the acute clinical condition is associated with prompt resolution of the volcanic mountain sign.