Evaluation of myocardial infarction by a 12-lead routine electrocardiogram: a case report of an ST-segment elevation.

Abstract

The spiked helmet sign (SHS) is a type of ST-segment elevation associated with critical cardiac disease and a high risk of death. We report a case of SHS caused by an ECG artifact. A 60-year-old male patient presented to the clinic after suffering an electric shock. The initial 12-lead routine elec-trocardiogram showed an SHS. The patient received appropriate intravenous fluid replacement therapy, and after 30 minutes, the ST-T changes of the 12-lead electrocardiogram were all restored to normal. The patient was discharged after a 24-hour observation period in the emergency room.Recent studies have pointed out that there may be two different types of SHS. One is the mechanical factor, and the other is the significant prolongation of the QT interval. The two types have different clinical significance. In our report, the radial artery of the patient’s right wrist pulsed strongly, and after the occurrence of SHS, the SHS disappeared after adjusting the contact position of the electrode in his right arm. This SHS caused by mechanical traction was an ECG artifact.Although the SHS may be an essential indicator of critical illness, there are mechanical factors that lead to the appearance of ECG artifacts. Therefore, in clinical work, obtaining a complete medical history and primary conditions of the patient at the time of ECG sampling is necessary to help the diagnosis and thus avoid er-roneous treatment.