ECG of the Month: The Spiked Helmet Sign: A Concerning Electrocardiographic Finding (JACC: Case Reports)

Editor's Note: This ECG of the Month was adapted from a JACC: Case Reports ECG Challenge. You can access the original article here.

An 18-year-old man with a history of motor vehicle accident complicated by subarachnoid hemorrhage and quadriplegia presented to the hospital with hypoxic respiratory failure and sepsis secondary to aspiration pneumonia. The patient spent 1 month in the intensive care unit and required mechanical ventilation. Following extubation, the patient had recurrent aspiration events as he was unable to clear oral and gastric secretions from his airway. His stay was further complicated by nosocomial coronavirus disease-2019 infection and new aspiration pneumonia. His telemetry monitoring showed changes with tachycardia and T-wave changes. The 12-lead electrocardiogram (ECG) that was obtained is shown in Figure 1.

Figure 1: Electrocardiogram Obtained During Hospitalization

Figure 1

The following are shown: pseudo ST-segment elevations, which begin prior to the QRS complex, seen in nearly all leads and most notably in V3-V6. Pseudo ST-segment depressions with similar pattern are noted in aVR and V1. Heart rate is regular at 126 beats/min.

This ECG pattern is mostly associated with which of the following?

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