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 ( 1 Hanna E.B. Glancy D.L. ST-segment elevation: differential diagnosis, caveats. Cleve Clin J Med. 2015; 82: 373-384 Crossref PubMed Scopus (26) Google Scholar ). 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.