Pickelhaube Sign

The Pickelhaube is a spiked helmet that was worn in the 19th and 20th centuries by the Prussian and German military. And the pickelhaube sign are thought to be noninvasive echocardiographic markers associated with sudden cardiac death in myxomatous mitral valve prolapse. Recently MITRAL VALVE PROLAPSE is getting more importance as one of the major causes of Arrhythmia, Sudden Cardiac Death(SCD) among young healthy people.

Recommended regular use of TISSUE DOPPLER ECHOCARDIOGRAPHY of Mitral Annulus revealing a high-velocity spike in the Tissue Doppler Velocity profile of the lateral mitral valve annulus which resemble pickel haube. An annular spike > 16 cm/sec adds to the emerging risk markers of arrhythmogenic MVP [mitral valve prolapse] syndrome.

Clinical Presentation
  1. Nonspecific chest pain in young
  2. Palpitations Often with anxiety
  3. Frequent complex ventricular ectopic
  4. Ventricular bigeminy or VT and PVC
  5. Near Syncope.
  1. MVP patients with no symptoms often require no treatment.
  2. MVP patients with symptoms of dysautonomia (chest pain, palpitations), should be treated with beta-blockers such as propranolol.
  3. MVP with severe mitral regurgitation may benefit from mitral valve repair or mitral valve replacement. ACC/AHA guidelines recommend mitral valve repair before symptoms of congestive heart failure


Denise Ignatowski et.al, Sandy N. Shah, Manesh Kumar Gangwani, Tony I. Oliver, Semantic Scholar

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