Spiked Helmet Sign

Although the presence of ST-segment elevations on a 12- lead electrocardiogram (ECG) is concerning for an acute coronary syndrome, it is essential to work up additional diagnostic possibilities beyond the most obvious. Herein we present a case of a 71-year-old woman with a history of hypertension, hyperlipidemia, myelofibrosis s/p allogeneic stem cell transplant (2019) complicated by Graft versus Host Disease admitted for nausea, epigastric discomfort, chest pressure and shortness of breath. Her medications included amlodipine, losartan, simvastatin, tacrolimus, ruxolitinib, and methylprednisolone.