Key result
Repositioning limb electrodes away from arterial pulsations normalizes pseudo-ischemic ST-T changes and QT prolongation.
Case Report (n=1)
No
Arterial pulsation artifacts can mimic the spiked helmet sign on an ECG, which can be resolved by systematic differentiation and deliberate electrode repositioning guided by Einthoven's triangle theory.
Electrode repositioning may exclude arterial pulsation artifacts mimicking ischemia; leaves open generalizability beyond this single case.
This case report presents an 86-year-old female patient admitted for the surgical evaluation of a mediastinal cystic mass. Initial electrocardiogram (ECG) showed ST-segment and T-wave changes resembling the spiked helmet sign. Considering the patient's stable vital signs and the absence of ST-segment changes in lead I, the possibility of ECG interference was suspected. Further investigation and repeated ECG, with adjustments to electrode placement away from the left lower limb artery, confirmed that the changes were due to arterial pulsation interference rather than a true cardiac abnormality. This case highlights the critical need to differentiate true cardiac ischemia from artifact-mediated ECG changes, particularly in hemodynamically stable patients.
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Ding et al. (2026) conducted a case report in ECG artifact mimicking spiked helmet sign (n=1). Electrode repositioning (left lower limb electrode placed on anterolateral thigh) vs. Standard ECG electrode placement was evaluated on Normalization of ECG abnormalities (ST-T changes and QT interval). Electrode repositioning away from the left lower limb artery resulted in complete normalization of the ST-T changes and QT interval, confirming an arterial pulsation artifact.
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