{"id":185,"date":"2019-06-19T12:01:57","date_gmt":"2019-06-19T10:01:57","guid":{"rendered":"https:\/\/admsu.org\/w\/?p=185"},"modified":"2019-06-19T12:01:57","modified_gmt":"2019-06-19T10:01:57","slug":"ecg-n5-reponse","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/ecg-n5-reponse\/","title":{"rendered":"ECG n\u00b05 &#8211; R\u00e9ponse"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"991\" height=\"539\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/unnamed-file-1.jpg\" alt=\"\" class=\"wp-image-186\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/unnamed-file-1.jpg 991w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/unnamed-file-1-300x163.jpg 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/unnamed-file-1-768x418.jpg 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>R\u00e9glages normaux<\/li><li>Rythme irr\u00e9gulier, tachycardie avec FC ~150bpm<\/li><li>Pas d&#8217;ondes P clairement visualis\u00e9es<\/li><li>QRS fins, pas de sch\u00e9ma ventriculaire r\u00e9p\u00e9t\u00e9 sur le trac\u00e9 long<\/li><li>Axe gauche<\/li><li>Pas de trouble de repolarisation<\/li><\/ul>\n\n\n\n<p>=> Tachycardie supra ventriculaire sur fibrillation atriale<\/p>\n\n\n\n<p>Devant toute tachycardie (FC > 100 bpm) : QRS larges ou fins ? Activit\u00e9 atriale ? Rythme ventriculaire r\u00e9gulier ? Sch\u00e9ma ventriculaire ?<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pr\u00e9sentation : Tachycardie \u00e0 QRS fins<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">R\u00e9guli\u00e8re<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Tachycardie sinusale\/atriale ectopique<\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li>Ondes P visibles, rythme ventriculaire r\u00e9gulier<ol><li>Par ph\u00e9nom\u00e8ne adaptatif sur \u00e9tiologie extra cardiaque : an\u00e9mie, sepsis, EP, hyperthyro\u00efdie, sevrage, grossesse, toxique.<\/li><li>En lien avec un foyer ectopique atrial. On retrouve des ondes P&#8217; dont la morphologie diff\u00e8re des ondes P du rythme sinusal.<\/li><\/ol><\/li><\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Flutter<\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li>Activit\u00e9 atriale rapide \u00e0 environ 300 bpm et r\u00e9ponse ventriculaire plus lente.<\/li><li>Les ondes P se suivent sans retour \u00e0 la ligne iso\u00e9lectrique donnant un aspect de sinuso\u00efde &#8220;en toit d&#8217;usine&#8221;.<\/li><li>La conduction auriculo ventriculaire peut \u00eatre satur\u00e9e (p\u00e9riode r\u00e9fractaire) par l&#8217;afflux \u00e9lectrique atriale provoquant une activit\u00e9 ventriculaire plus ou moins r\u00e9guli\u00e8re (flutter \u00e0 conduction variable).<\/li><\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Tachycardie Jonctionnelle<\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li>Les \u00e9tiologies sont multiples et le diagnostic compliqu\u00e9 tant l&#8217;analyse du trac\u00e9 doit \u00eatre minutieuse. Il faut si possible analys\u00e9 le mode d&#8217;entr\u00e9e dans cette tachycardie avec un trac\u00e9 d\u00e9crivant le moment de transition et ensuite faire une analyse fine de l&#8217;auriculo-ventriculogamme.<ol><li>Tachycardie par r\u00e9 entr\u00e9e intranodale (TRIN)<\/li><li>Tachycardie par voie accessoire (WPW)<\/li><\/ol><\/li><\/ul>\n\n\n\n<p>C&#8217;est deux \u00e9l\u00e9ments seront d\u00e9taill\u00e9s dans une autre pr\u00e9sentation.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Irr\u00e9guli\u00e8re<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Fibrillation atriale<\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li>Activit\u00e9 m\u00e9canique anarchique des oreillettes avec perte de contractilit\u00e9 efficace provoqu\u00e9e par une activit\u00e9 \u00e9lectrique d\u00e9sordonn\u00e9e. Aspect de tr\u00e9mulation de la ligne de base.<\/li><li>Intervalle RR qui est variable, expliquant l&#8217;irr\u00e9gularit\u00e9 de la cadence ventriculaire.<\/li><\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Tachycardie atriale multifocale<\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li>Forme particuli\u00e8re de tachycardie atriale. Il existe au moins 3 ondes P&#8217; d&#8217;activit\u00e9 irr\u00e9guli\u00e8re.<\/li><li>Pr\u00e9c\u00e8de souvent un passage en FA<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Bibliographie<\/h2>\n\n\n\n<p><em>Saoudi N, Deharo JC.\nPr\u00e9cis de rythmologie. \u00c9diteur Paris, Sauramps M\u00e9dical 2005. <\/em><\/p>\n\n\n\n<p><em>Fuster V, Ryden LE,\nCannom DS, et al. <\/em><em>ACC\/AHA\/ESC 2006 Guidelines for the management\nof patients with atrial fibrillation: a report of the american college of\ncardiology\/american heart association task force on practice guidelines and the\neuropean society of cardiology committee for practice guidelines (writing\ncommittee to revise the 2001 Guidelines for the management of patients with\natrial fibrillation): developed in collaboration with the european heart rhythm\nassociation and the heart rhythm society. Circulation 2006 ; 114 (7) :\ne257-354.<\/em><\/p>\n\n\n\n<p><a href=\"https:\/\/www.sfmu.org\/upload\/70_formation\/02_eformation\/02_congres\/Urgences\/urgences2008\/donnees\/pdf\/035_torres.pdf\">https:\/\/www.sfmu.org\/upload\/70_formation\/02_eformation\/02_congres\/Urgences\/urgences2008\/donnees\/pdf\/035_torres.pdf<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/sfcardio.fr\/sites\/default\/files\/Enseignement\/CNEC\/Ref_Cardiologie.pdf\">https:\/\/sfcardio.fr\/sites\/default\/files\/Enseignement\/CNEC\/Ref_Cardiologie.pdf<\/a><\/p>\n\n\n\n<p><a href=\"http:\/\/www.e-cardiogram.com\/ecg-lexique_alpha.php?terme_lex=t&amp;id_lex=603\">http:\/\/www.e-cardiogram.com\/ecg-lexique_alpha.php?terme_lex=t&amp;id_lex=603<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Interpr\u00e9tation R\u00e9glages normaux Rythme irr\u00e9gulier, tachycardie avec FC ~150bpm Pas d&#8217;ondes P clairement visualis\u00e9es QRS fins, pas de sch\u00e9ma ventriculaire r\u00e9p\u00e9t\u00e9 sur le trac\u00e9 long Axe gauche Pas de trouble de repolarisation => Tachycardie supra ventriculaire sur fibrillation atriale Devant toute tachycardie (FC > 100 bpm) : QRS larges ou fins ? Activit\u00e9 atriale ? &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/admsu.org\/w\/ecg-n5-reponse\/\" class=\"more-link\">Continuer la lecture<span class=\"screen-reader-text\"> de &laquo;&nbsp;ECG n\u00b05 &#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":[27,28,29],"class_list":["post-185","post","type-post","status-publish","format-standard","hentry","category-ecg-commente","tag-fibrillation-atriale","tag-tachycardie-a-qrs-fins","tag-tachycardie-irreguliere"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/185","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=185"}],"version-history":[{"count":3,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/185\/revisions"}],"predecessor-version":[{"id":189,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/185\/revisions\/189"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=185"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=185"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=185"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}