To the Editor:
It is with great interest that we read the article of Littmann and Monroe in which they presented electrocardiograms suggestive of ST-segment elevation myocardial infarction in patients who were found not to have ST-segment elevation myocardial infarction.1 Typical of those cases were a critical illness, a unique dome-and-spike pattern always in the inferior leads, and high in-hospital mortality.
We recently reported a case in which the “spiked helmet” sign appeared in the anteroapical leads (Figure).2 Coronary angiography excluded coronary artery disease as a cause of ST-segment elevation. The cause of death, as established by autopsy, was traumatic aortic dissection due to a car accident. The morphology of the ST-segment elevation resembled the second case in the series of Littmann and Monroe. The exact mechanism of this pseudo–ST-segment elevation is not known, but in the case of inferior ST-segment elevation, the proposed mechanism was diaphragmatic movement or an acute rise in intra-abdominal pressure. In our case, an acute rise in intrathoracic pressure due to aortic dissection may have been the cause of the pseudo–ST-segment elevation.
FIGURE.
The “spiked helmet” sign. Atrial fibrillation and ST-segment elevation in leads V2 through V4. The dome-and-spike sign is most pronounced in leads V3 and V4.
Reprinted from J Electrocardiol,2 with permission from Elsevier.
References
- 1.Littmann L., Monroe M.H. The “spiked helmet” sign: a new electrocardiographic marker of critical illness and high risk of death. Mayo Clin Proc. 2011;86(12):1245–1246. doi: 10.4065/mcp.2011.0647. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Tomcsányi J., Arabadzisz H., Bózsik B. An etiology of ST-segment elevation. J Electrocardiol. 2008;41(6):696. doi: 10.1016/j.jelectrocard.2008.03.004. [DOI] [PubMed] [Google Scholar]