title: Spiked helmet sign: An under-recognized electrocardiogram finding in critically ill patients.
abstract: A 77-year-old male patient presented with rhabdomyolysis. He developed progressive respiratory failure and acute respiratory distress syndrome during his hospital stay requiring mechanical ventilation. An electrocardiogram during mechanical ventilation showed findings suggestive of ST elevation myocardial infarction. Closer review showed dome and spike findings that have been likened to a "spiked helmet." This finding has been associated with significant mortality. We discuss this under-recognized finding and the potential contributing mechanisms.
authors.affiliation: Department of Medicine, Dayton Veteran Affairs Medical Center, Dayton, OH 45428, USA ; Wright State University, Dayton, OH 45409, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Medicine, Dayton Veteran Affairs Medical Center, Dayton, OH 45428, USA ; Wright State University, Dayton, OH 45409, USA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Janz
authors.affiliation: Wright State University, Dayton, OH 45409, USA.
authors.forename: Naga V
authors.initials: NV
authors.lastname: Garikipati
keywords: Critical illness; electrocardiogram; mortality; myocardial infarction