A change in the electrocardiogram that has been likened to a Prussian army helmet (Pickelhaube) is associated with a poor prognosis.
Features of the "German spiked helmet" change in the ECG:
(1) pseudo-ST segment elevation with upward shift starting before the onset of the QRS complex.
(2) the elevated segment is hemispherical with a sudden narrow "spike" in the middle.
(3) present in the inferior leads (II, III, aVF)
(4) the serum troponin concentration is normal
(5) there is no clinical evidence of myocardial infarction
(6) there is no evidence of a ventricular wall abnormality in echocardiogram
The sign is associated with:
(1) noncardiac disease (often intra-abdominal) in a critically-ill patient
(2) a poor prognosis
