{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T16:59:04Z","timestamp":1793033944279,"version":"4.5.0"},"reference-count":12,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T00:00:00Z","timestamp":1635724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The grant of Taipei Tzu Chi Hospital .","award":["(TCRD-TPE-110-31, TCRD-TPE-110-34, TCRD-TPE-110-48)"],"award-info":[{"award-number":["(TCRD-TPE-110-31, TCRD-TPE-110-34, TCRD-TPE-110-48)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Spiked helmet sign is a novel electrocardiogram marker that reflects a poor prognosis, and may mimic myocardial infarction, especially in patients with an acute alteration of mental status or out-of-hospital cardiac arrest. In cases where a spiked helmet sign is missed, there may be a delay in surgical intervention for the underlying conditions because of unnecessary cardiac catheterization. In addition, antiplatelet agents for acute coronary syndrome in such cases can lead to catastrophic complications. Therefore, early recognition of spiked helmet sign is useful for timely correction of the underlying disease and prevention of poor outcomes. Herein, we describe a rare case of a patient with internal bleeding and subarachnoid hemorrhage presenting with spiked helmet sign on an electrocardiogram.<\/jats:p>","DOI":"10.3390\/medicina57111184","type":"journal-article","created":{"date-parts":[[2021,11,1]],"date-time":"2021-11-01T22:22:24Z","timestamp":1635805344000},"page":"1184","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Spiked Helmet Sign Predicting a Poor Outcome in a Patient with Non-Myocardial Infarction ST-Segment Elevation"],"prefix":"10.3390","volume":"57","author":[{"given":"Shu-Yu","family":"Shih","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan"},{"name":"Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-5125-0771","authenticated-orcid":false,"given":"Yueh-Tseng","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan"},{"name":"Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Chen","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan"},{"name":"Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1004-312X","authenticated-orcid":false,"given":"Yu-Long","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan"},{"name":"Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Da-Sen","family":"Chien","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan"},{"name":"Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8473-3591","authenticated-orcid":false,"given":"Giou-Teng","family":"Yiang","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan"},{"name":"Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8773-1847","authenticated-orcid":false,"given":"Meng-Yu","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan"},{"name":"Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","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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Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1152\/physrev.1999.79.3.917","article-title":"Cardiac Ionic Currents and Acute Ischemia: From Channels to Arrhythmias","volume":"79","author":"Carmeliet","year":"1999","journal-title":"Physiol. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jelectrocard.2019.04.011","article-title":"Is the Spiked Helmet Sign the Manifestation of Long Qt Syndrome?","volume":"55","author":"Simon","year":"2019","journal-title":"J. Electrocardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.mayocp.2012.01.005","article-title":"St Elevation Anterior \u201cSpiked Helmet\u201d Sign","volume":"87","year":"2012","journal-title":"Mayo Clin. 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Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","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":"ref_12","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.jelectrocard.2018.11.016","article-title":"Spiked Helmet Pattern St Elevation in Subarachnoid Hemorrhage","volume":"52","author":"Laundon","year":"2019","journal-title":"J. Electrocardiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/11\/1184\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:24:14Z","timestamp":1760167454000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/11\/1184"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,1]]},"references-count":12,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["medicina57111184"],"URL":"https:\/\/doi.org\/10.3390\/medicina57111184","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,1]]}}}