Key result
Spiked helmet sign mimics STEMI in a structurally normal donor heart during noncardiac critical illness.
Why the study?
The occurrence and significance of the spiked helmet sign in the early post-heart transplantation period in structurally normal donor hearts was previously unreported.
Case Report (n=1)
This case highlights that the spiked helmet sign can occur in a structurally normal transplanted heart as an extracardiac, neurocardiogenic response to severe systemic stress, mimicking a STEMI and carrying a dismal prognosis.
Answers are grounded in this paper and cite their sources.
Spiked helmet sign can occur in structurally normal post-transplant hearts; extends its link to critical illness but leaves management implications open.
A 36-year-old woman with severe dilated cardiomyopathy (LVEF 14%, NYHA IV) underwent heart transplantation. Postoperatively, she developed subarachnoid hemorrhage and septic shock. The ECG revealed a spiked helmet sign (SHS) pattern, with repolarization abnormalities and QT prolongation. Despite transient clinical improvement and resolution of the ECG changes after intensive support, the patient died due to infectious complications. This case highlights the occurrence of SHS in the early posttransplant period in a structurally normal donor heart, a previously unreported presentation, reinforcing its extracardiac origin and association with critical illness and poor prognosis.
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Macedo et al. (2026) conducted a case report in Dilated cardiomyopathy, heart transplantation, subarachnoid hemorrhage, septic shock (n=1). Critical illness (subarachnoid hemorrhage and septic shock) was evaluated on Clinical outcome and ECG presentation. The spiked helmet sign, a dramatic STEMI mimic, occurred in a structurally normal donor heart post-transplantation in the setting of subarachnoid hemorrhage and septic shock.
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