scholarly journals The “Spiked Helmet” Sign Associated with ST-Elevation Myocardial Infarction: A Case Report

2021 ◽  
Vol 2 (5) ◽  
pp. 152-154
Author(s):  
Bruno Minotti ◽  
Jörg Scheler ◽  
Robert Sieber ◽  
Eva Scheler

Introduction: The “spiked helmet” sign was first described in 2011 by Littmann and Monroe in a case series of eight patients. This sign is characterized by an ST-elevation atypically with the upward shift starting before the onset of the QRS complex. Nowadays the sign is associated with critical non-cardiac illness. Case Report: An 84-year-old man with a history of three-vessel disease presented to the emergency department with intermittent pain in the upper abdomen. The electrocardiogram revealed the “spiked helmet” sign. After ruling out non-cardiac conditions the catherization lab was activated. The coronary angiography revealed an acute occlusion of the right coronary artery, which was balloon-dilated followed by angioplasty. The first 24 hours went uneventfully with resolution of the “spiked helmet” sign. On the second day, however, the patient died suddenly and unexpectedly. Conclusion: Despite the association with non-cardiac illness, the “spiked helmet” sign can be seen by an acute coronary artery occlusion as an ST-elevation myocardial infarction (STEMI). Reciprocal ST-depression in these cases should raise the suspicion of STEMI.

2012 ◽  
Vol 76 (2) ◽  
pp. 414-422 ◽  
Author(s):  
Simcha R. Meisel ◽  
Michael Shochat ◽  
Aaron Frimerman ◽  
Aya Asif ◽  
David S. Blondheim ◽  
...  

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Ki Fung Cliff Li ◽  
Hee Hwa Ho ◽  
Min Sen Yew

Abstract Background Dipyridamole stress is commonly used for myocardial perfusion imaging and is generally safe. Myocardial ischaemia can occasionally occur and is classically thought to be due to coronary steal as a result of redistribution of flow away from collateral dependent myocardium. Although ischaemia more commonly presents as electrocardiographic (ECG) ST depression and angina, ST-elevation myocardial infarction may occur as a very rare complication. Case summary We report a case of a patient who developed chest pain and ST depression during dipyridamole infusion. The pain persisted despite intravenous aminophylline with new inferior ST elevation soon after. Coronary angiography showed subtotal right coronary artery occlusion with no collateral supply. The symptoms and ECG changes resolved after percutaneous coronary intervention. Discussion Coronary steal may not fully account for our patient’s presentation given the failure of aminophylline and absent angiographic collaterals. Vasospasm may be triggered by dipyridamole and can directly cause ischaemia or provoke rupture of an unstable plaque. Augmentation of cardiac energetics during vasodilator stress may also play a role.


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