Visual Diagnosis in Emergency Medicine| Volume 57, ISSUE 3, P390-394, September 2019

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Utilization of the Electrocardiographic “Spiked Helmet” Sign in the Diagnosis of Intra-Abdominal Pathology Within the Emergency Setting

      The differential diagnosis of electrocardiographic (ECG) ST-segment elevation includes a multitude of cardiopulmonary pathologies, including myocardial infarction, pericarditis, myocarditis, pulmonary embolism, takotsubo syndrome, ventricular aneurysm, and Brugada syndrome, among others (
      • Hanna E.B.
      • Glancy D.L.
      ST-segment elevation: differential diagnosis, caveats.
      ). However, under the appropriate clinical presentation, this ECG finding expands to include extrathoracic pathology as part of the differential. A lesser-known manifestation of ST-segment elevation referred to as the “spiked helmet” sign (SHS) may represent a key diagnostic clue to the emergency provider of a critically evolving intra-abdominal pathology. We present a case in which the ECG findings of the SHS provided a diagnostic clue and expedited the diagnosis and management of a patient with severe intra-abdominal pathology.
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