Background: The “Spiked Helmet sign” (SHS) on electrocardiogram (ECG) is a rare and distinctive pattern of ST elevation resembling a traditional spiked German military helmet. Counterintuitively, it is typically not associated with cardiac conditions.

Spiked helmet sign is an uncommon ST elevation manifestation of gastric dilatation likely due to gastric distention-induced vagal stimulation affecting cardiac repolarization. ST elevations in the ECGs of acutely ill patients can have different causes, e.g., left bundle branch block (LBBB), early repolarization, pericarditis, TakoTsubo cardiomyopathy, and gastric dilatation. Recognition of the underlying cause is crucial to accurate diagnosis and appropriate management.

We report a case of gastric dilatation with this ECG phenomenon. 

Gabriela Strey studied Medicine from 1988 -1994 in Germany and completed her Doctoral thesis at the Humboldt University Berlin in 2001. Since 2006 she works as a Senior Staff Specialist Internal Medicine/Endoscopy in Hervey Bay/Australia. She has published in several journals and presented posters and free papers at various conferences.