• Bryan Richard Sasmita, Suxin Luo, and Bi Huang.
• Department of Cardiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
• Medicine (Baltimore). 2023 Oct 27; 102 (43): e35661e35661.

RationaleST-segment elevation on electrocardiogram (ECG) is an alarming sign. Although acute myocardial infarction (AMI) is the most common cause of ST-segment elevation, many non-ischemic conditions may produce pseudo-ST segment elevation. Spiked Helmet (SH) sign is one of the pseudo-ST segment elevations that is associated with critical illness and high risk of death. SH sign was characterized by an upward shift starting before the onset of the QRS complex; however, we found some patients presented with a peculiar characteristic on ECG with an upward convex ST-segment elevation after the QRS wave but without elevation before the QRS wave, therefore called Semi-SH sign. Also, this electrocardiographic feature exists in patients with critical disease and is related to poor prognosis. The purpose of this case series is to describe the electrocardiographic Semi-SH sign and enhance the awareness of such electrocardiographic manifestation for clinicians.Patients ConcernsThis case series explores the possibility of severe infection induced electrocardiographic changes resembling spiked-helmet sign.DiagnosesSepsis-induced secondary myocardial injury or coronary vasospasm.InterventionsGastric decompression, antibiotics, diuretics, advanced life support.OutcomesThe outcome of this case series is the association of the electrocardiographic Semi-SH sign with the prognosis. All 3 patients died several days post manifestation of electrocardiographic Semi-SH sign.LessonLike SH sign, electrocardiographic Semi-SH sign is a life-threatening or deadly ECG sign, and therefore early recognition and aggressive treatment are important.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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