{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T12:57:00Z","timestamp":1764161820191,"version":"3.46.0"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T00:00:00Z","timestamp":1764115200000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The \u2018spiked helmet\u2019 sign is a rare electrocardiographic (ECG) phenomenon characterized by transient ST-segment elevations mimicking an acute coronary syndrome, typically seen in critically ill patients. While often associated with severe physiological stress, its presence in sepsis is particularly uncommon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>A 68-year-old male with a history of hypertension and diabetes mellitus presented to the emergency department with fever, altered mental status, and hypotension. Initial workup revealed severe sepsis secondary to pneumonia. His ECG showed pronounced ST-segment elevations in leads II, III, and aVF, with a distinctive \u2018spiked helmet\u2019 pattern. Troponin levels were mildly elevated, raising concerns for concurrent myocardial ischemia. However, the patient denied chest pain, and further cardiac evaluation, including echocardiography, showed no evidence of ischemia or infarction. Intensive care management included broad-spectrum antibiotics, intravenous fluids, and vasopressors. Despite the severity of his illness, the patient\u2019s condition gradually improved, and repeat ECGs showed resolution of the ST-segment elevations. The \u2018spiked helmet\u2019 sign was attributed to severe sepsis-induced autonomic dysfunction rather than primary cardiac pathology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the importance of recognizing the \u2018spiked helmet\u2019 sign as a marker of severe stress in critically ill patients, which may mimic myocardial ischemia on ECG. Prompt differentiation between this sign and true ischemia is crucial to avoid unnecessary interventions and focus on managing the underlying critical illness.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/omcr\/omaf232","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T12:05:50Z","timestamp":1759320350000},"source":"Crossref","is-referenced-by-count":0,"title":["The spiked helmet sign in severe sepsis: an unusual electrocardiographic finding in a critically ill patient"],"prefix":"10.1093","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6155-7302","authenticated-orcid":false,"given":"Hashim","family":"Manea","sequence":"first","affiliation":[{"name":"Vascular Surgery Department, Oregon Health and Science University , 110 N Tomahawk island Dr, Portland, OR, 97217,","place":["United States"]},{"name":"University of Warith Al-Anbiyaa, College of Medicine , Oun street, Karbala, 10072","place":["Iraq"]},{"name":"Department of Clinical Research, University of Jamestown , Nassiryah, Thi Qar, 64001, Jamestown, ND ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9076-8220","authenticated-orcid":false,"given":"Ahmed Qasim Mohammed","family":"Alhatemi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Al Nasiriyah Teaching Hospital , Nassiryah, Thi Qar, 64001,","place":["Iraq"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammedbaqer Ali","family":"Al-Ghuraibawi","sequence":"additional","affiliation":[{"name":"University of Warith Al-Anbiyaa, College of Medicine , Oun street, Karbala, 10072","place":["Iraq"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ghaith Asaad","family":"Alhumairi","sequence":"additional","affiliation":[{"name":"Royal Shrewsbury Hospital , Mytton Oak Road, Shrewsbury, SY3 8XQ,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali Saad","family":"Al-Shammari","sequence":"additional","affiliation":[{"name":"College of Medicine, university of Baghdad , Nahdha, Baghdad, 10048,","place":["Iraq"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8575-0119","authenticated-orcid":false,"given":"Abdullah Muataz Taha","family":"Al-Ibraheem","sequence":"additional","affiliation":[{"name":"Al-Kindy College of Medicine, university of Baghdad , Nahdha, Baghdad, 10048,","place":["Iraq"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrar","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department if Medicine, University of Stavanger , Mail box 8600, 4036 Stavanger,","place":["Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hussein Safaa","family":"Abdulammer","sequence":"additional","affiliation":[{"name":"Anesthesia Techniques Department, College of Health and Medical Techniques, Al-Mustaqbal University , Babylon 51001 ,","place":["Iraq"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,11,26]]},"reference":[{"key":"2025112607525876500_ref1","doi-asserted-by":"publisher","first-page":"260","DOI":"10.12691\/ajmcr-7-10-9","article-title":"Helmet sign on EKG: a rare indicator of poor prognosis in critically ill patients","volume":"7","author":"Oluyadi","year":"2019","journal-title":"Am J Med Case Rep"},{"key":"2025112607525876500_ref2","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.4065\/mcp.2011.0647","article-title":"The \u201cspiked helmet\u201d sign: a new electrocardiographic marker of critical illness and high risk of death","volume":"86","author":"Littmann","year":"2011","journal-title":"Mayo Clin 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elevation","volume":"57","author":"Shih","year":"2021","journal-title":"Medicina."},{"key":"2025112607525876500_ref6","doi-asserted-by":"publisher","first-page":"e254546","DOI":"10.1136\/bcr-2022-254546","article-title":"Electrocardiographic spiked-helmet sign in critical non-cardiac illness","volume":"16","author":"Narvaez-Guerra","year":"2023","journal-title":"BMJ Case Rep CP"},{"key":"2025112607525876500_ref7","doi-asserted-by":"publisher","first-page":"103412","DOI":"10.1016\/j.jaccas.2025.103412","article-title":"A distinctive electrocardiographic pattern: unveiling the spiked helmet sign","volume":"30","author":"Bosnjak","year":"2025","journal-title":"JACC Case Rep"}],"container-title":["Oxford Medical Case 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