20/08/2025
๐ฉบ๐๐ฉ๐ข๐ค๐๐ ๐๐๐ฅ๐ฆ๐๐ญโ ๐๐ข๐ ๐ง:
New ECG Marker of
Critical Illness and High Risk of Death
=================================
Spiked Helmet Sign (SHS) is
ECG marker associated with increased risk of
lethal ventricular tachyarrhythmias and
sudden cardiac death.
SHS formation is attributed to sympathetic hyperactivity, which mediates increased dispersion of ventricular repolarization, leading to marked QT prolongation and macroscopic T-wave alternans.
This pattern can be observed in critically ill patients with cardiac or noncardiac conditions. In particular, immediate identification of this ECG abnormality is crucial in recognizing and treating noncardiac conditions in older male patients.
๐๐๐๐จ ๐ฅ๐๐ฉ๐ฉ๐๐ง๐ฃ ๐๐จ ๐๐๐๐ง๐๐๐ฉ๐๐ง๐๐ฏ๐๐ ๐๐ฎ โฃ๏ธ
โข slurring or notching J-point elevation,
โข subsequent downsloping ST-segment elevation,
โข wide T(U)-wave inversion in the inferior leads,
โข suggesting a combination of J-point,
elevated ST segment, and T-wave.
ECG showed Dome-and-Spike Pattern,
Giving the appearance of Pickelhaube,
German military spiked helmet
introduced in 1842 by Friedrich Wilhelm IV,
King of Prussia (Figure).
๐๐๐๐๐๐ฃ๐๐จ๐ข
Certain pathological conditions can rarely result in Repetitive contraction of the diaphragm
that is in concert with the cardiac cycle.
Such diaphragmatic contractions may result in Alteration of the ST segment,
which is best seen in the inferior leads.
๐ฎ ๐๐ช๐ก๐จ๐๐ฉ๐๐ก๐ ๐ฟ๐๐๐ฅ๐๐ง๐๐๐ข๐๐ฉ๐๐ ๐ข๐ค๐ฉ๐๐ค๐ฃ ๐๐๐๐๐๐ฃ๐๐จ๐ข
โโโโโโโโโโโโโโโโโโโโโโ
โข Direct stimulation of the diaphragm
by the inferior wall of the left ventricle or
โข Triggering of the left leaf of the diaphragm
by the left phrenic nerve.
โข Repetitive Epidermal stretch in association
with Nearby pulsatile flow or due to
Acute rise in Intrathoracic or Intra-abdominal pressure.
๐พ๐ค๐ฃ๐๐ก๐ช๐จ๐๐ค๐ฃ
The spiked helmet sign is a potential novel ECG marker of a very high risk of impending death,
but the prevalence, mechanism, and clinical applicability remain uncertain at this time.
Repetitive signals in the ECG that are not generated by cardiac depolarization or repolarization have previously been shown to provide important clues to patientsโ clinical conditions and guidance on their treatment.
Further experience is needed to determine whether the spiked helmet sign will eventually change clinical management or just remain an electric curiosity.
๐https://t.me/cardiology
