{"id":176,"date":"2019-06-13T20:17:55","date_gmt":"2019-06-13T18:17:55","guid":{"rendered":"https:\/\/admsu.org\/w\/?p=176"},"modified":"2019-06-13T20:17:55","modified_gmt":"2019-06-13T18:17:55","slug":"ecg-n4-reponse","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/ecg-n4-reponse\/","title":{"rendered":"ECG n\u00b04 &#8211; R\u00e9ponse"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"556\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/correction-1024x556.png\" alt=\"\" class=\"wp-image-178\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/correction-1024x556.png 1024w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/correction-300x163.png 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/correction-768x417.png 768w\" sizes=\"auto, (max-width: 767px) 89vw, (max-width: 1000px) 54vw, (max-width: 1071px) 543px, 580px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Interpr\u00e9tation<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>Rythme sinusal et r\u00e9gulier (onde P indiqu\u00e9es par <em>fl\u00e8che rouge<\/em>)<\/li><li>FC \u00e0 100 bpm<\/li><li>Axe gauche<\/li><li>Retard de progression des ondes R avec transition tardive en V5<\/li><li>QRS fins, pas d&#8217;onde de n\u00e9crose<\/li><li>Segment ST iso-\u00e9lectrique<\/li><li>Ondes T n\u00e9gatives en forme de S italique<\/li><li>QTc \u00e0 558ms<\/li><\/ul>\n\n\n\n<p>=&gt; \u00e9vocateur d&#8217;une hypokali\u00e9mie, impr\u00e9gnation en amiodarone ou quinine. <\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pr\u00e9sentation<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">\u00c9tiologie \u00e0 \u00e9voquer sur une onde T invers\u00e9e<\/h3>\n\n\n\n<p>Une onde T invers\u00e9e est n\u00e9gative dans les d\u00e9rivations o\u00f9 l&#8217;onde R est dominante ou positive dans les d\u00e9rivations o\u00f9 l&#8217;onde S est dominante.<\/p>\n\n\n\n<p>L&#8217;interpr\u00e9tation isol\u00e9e de la morphologie d&#8217;une onde T anormale est difficile et source d&#8217;erreur. Il faut toujours y associer l&#8217;interpr\u00e9tation du segment ST. La conclusion h\u00e2tive d&#8217;isch\u00e9mie myocardique n&#8217;est pas rare.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Physiologique<\/h4>\n\n\n\n<p>L&#8217;onde T est normalement n\u00e9gative en aVR et en V1; une inversion peut \u00e9galement \u00eatre physiologique de V1 \u00e0 V3 chez l&#8217;enfant ou chez l&#8217;athl\u00e8te; l&#8217;onde T peut \u00e9galement \u00eatre n\u00e9gative en DIII et plus rarement en aVF. Le terme inversion est utilis\u00e9 pour diff\u00e9rencier le cas de ce qui est le plus fr\u00e9quemment d\u00e9crit, en revanche il ne s&#8217;agit pas d&#8217;une vraie inversion dans la mesure o\u00f9 elle est associ\u00e9e \u00e0 une onde S dominante.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Pathologique<\/h4>\n\n\n\n<p>Toute onde T n\u00e9gative sera consid\u00e9r\u00e9e pathologique lorsqu&#8217;elle est retrouv\u00e9e dans une d\u00e9rivation inattendue ou alors si elle est pr\u00e9c\u00e9demment d\u00e9crite comme \u00e9tant positive. Mais elle ne repr\u00e9sente rien de sp\u00e9cifique car observ\u00e9e dans de nombreuses situations.<\/p>\n\n\n\n<p><strong>Une atteinte syst\u00e9matis\u00e9e<\/strong> : isch\u00e9mique<\/p>\n\n\n\n<p><strong>Une atteinte diffuse<\/strong> : P\u00e9ricardite, trouble de conduction ou du rythme (bloc de branche, stimulateur, effet Chatterjee), hypertrophie ventriculaire, trouble m\u00e9tabolique, impr\u00e9gnation digitalique ou lithium, h\u00e9morragie sous arachno\u00efdienne.<\/p>\n\n\n\n<p>Lorsque l&#8217;atteinte est diffuse, associer la morphologie du segment ST, du QT et de l&#8217;onde T peut orienter vers l&#8217;\u00e9tiologie<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>ST <strong>descendant \u00e0 convexit\u00e9 sup\u00e9rieure<\/strong> : hypertrophie VG&nbsp;ou&nbsp;hypertrophie VD,&nbsp;d\u2019un&nbsp;bloc de branche&nbsp;ou d\u2019une&nbsp;pr\u00e9excitation<\/li><li>ST <strong>ascendant<\/strong> : trouble fonctionnel secondaire \u00e0 une&nbsp;tachycardie, un collapsus, une&nbsp;cardioversion&nbsp;ou une&nbsp;repolarisation atriale. Mais une \u00e9tiologie isch\u00e9mique ne peut \u00eatre \u00e9cart\u00e9e.<\/li><li>ST <strong>descendant en&nbsp;cupule<\/strong>&nbsp;: impr\u00e9gnation&nbsp;digitalique&nbsp;ou une&nbsp;hypercalc\u00e9mie.<\/li><li><strong>S italique couch\u00e9<\/strong> avec <strong>prolongation de l\u2019intervalle Q-T<\/strong>&nbsp;\u00e9voque une impr\u00e9gnation en&nbsp;amiodarone, en&nbsp;quinidine&nbsp;ou une&nbsp;hypokali\u00e9mie.<\/li><li><strong>sous d\u00e9calage mod\u00e9r\u00e9<\/strong> (\u2264 1 mm) mais diffus, avec&nbsp;microvoltage&nbsp;peut se rencontrer au cours d&#8217;un&nbsp;\u00e9panchement p\u00e9ricardique<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Bibliographie<\/h3>\n\n\n\n<p>Rautaharju, Pentti M., Borys Surawicz, et Leonard S. Gettes. \u00ab&nbsp;AHA\/ACCF\/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram&nbsp;\u00bb. <em>Journal of the American College of Cardiology<\/em> 53, n<sup>o<\/sup> 11 (mars 2009): 982\u201191. <a href=\"https:\/\/doi.org\/10.1016\/j.jacc.2008.12.014\">https:\/\/doi.org\/10.1016\/j.jacc.2008.12.014<\/a>.    <\/p>\n\n\n\n<figure class=\"wp-block-embed-wordpress wp-block-embed is-type-wp-embed is-provider-life-in-the-fast-lane-litfl-medical-blog\"><div class=\"wp-block-embed__wrapper\">\nhttps:\/\/litfl.com\/ecg-library\/\n<\/div><\/figure>\n\n\n\n<p><a href=\"http:\/\/www.e-cardiogram.com\/ecg-lexique_alpha.php?terme_lex=s&amp;id_lex=387\">http:\/\/www.e-cardiogram.com\/<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.cardiocases.com\/fr\">https:\/\/www.cardiocases.com\/fr<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Interpr\u00e9tation Rythme sinusal et r\u00e9gulier (onde P indiqu\u00e9es par fl\u00e8che rouge) FC \u00e0 100 bpm Axe gauche Retard de progression des ondes R avec transition tardive en V5 QRS fins, pas d&#8217;onde de n\u00e9crose Segment ST iso-\u00e9lectrique Ondes T n\u00e9gatives en forme de S italique QTc \u00e0 558ms =&gt; \u00e9vocateur d&#8217;une hypokali\u00e9mie, impr\u00e9gnation en amiodarone &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/admsu.org\/w\/ecg-n4-reponse\/\" class=\"more-link\">Continuer la lecture<span class=\"screen-reader-text\"> de &laquo;&nbsp;ECG n\u00b04 &#8211; R\u00e9ponse&nbsp;&raquo;<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[26,24,25],"class_list":["post-176","post","type-post","status-publish","format-standard","hentry","category-ecg-commente","tag-qt-long","tag-st-2","tag-t-negative"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/176","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/comments?post=176"}],"version-history":[{"count":4,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/176\/revisions"}],"predecessor-version":[{"id":183,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/176\/revisions\/183"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=176"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=176"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=176"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}