{"id":205,"date":"2019-06-27T12:09:38","date_gmt":"2019-06-27T10:09:38","guid":{"rendered":"https:\/\/admsu.org\/w\/?p=205"},"modified":"2019-06-27T12:09:38","modified_gmt":"2019-06-27T10:09:38","slug":"ecg-n6-reponse","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/ecg-n6-reponse\/","title":{"rendered":"ECG n\u00b06 &#8211; R\u00e9ponse"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"537\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/Maladie-de-loreillette-1024x537.png\" alt=\"\" class=\"wp-image-207\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/Maladie-de-loreillette-1024x537.png 1024w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/Maladie-de-loreillette-300x157.png 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/Maladie-de-loreillette-768x403.png 768w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/Maladie-de-loreillette.png 1149w\" 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>Activit\u00e9 atriale d\u00e9sordonn\u00e9e dessinant un &#8220;toit d&#8217;usine&#8221; en V1 et V2 \u00e0 une cadence de 300bpm<\/li><li>QRS fins, cadence ventriculaire lente \u00e0 36bpm<\/li><li>QTc=500ms<\/li><li>Onde T n\u00e9gative dans les d\u00e9rivations lat\u00e9rales (V4-V6) avec discret sous d\u00e9calage<\/li><\/ul>\n\n\n\n<p>La pr\u00e9sence d&#8217;une bradycardie extr\u00eame sans  rythme d&#8217;\u00e9chappement doit vous faire \u00e9voquer le diagnostic de SSS (Sinus Sick Syndrome), ce d&#8217;autant que le rythme sous jacent est une tachycardie supra-ventriculaire (un flutter probablement ici).<\/p>\n\n\n\n<p>Il existe \u00e9galement un trouble de repolarisation qui n&#8217;est pas en lien avec le SSS et doit faire l&#8217;objet d&#8217;exploration en fonction du contexte.<\/p>\n\n\n\n<p>M\u00eame si l&#8217;ECG est caract\u00e9ristique d&#8217;une SSS, il faut exclure un trouble m\u00e9tabolique sous jacent.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pr\u00e9sentation &#8211; SSS<\/h2>\n\n\n\n<p>L&#8217;\u00e9tiologie la plus fr\u00e9quente est la d\u00e9g\u00e9n\u00e9rescence cellulaire (fibrose) du n\u0153ud sinusal et\/ou de la jonction sino-auriculaire, fr\u00e9quente chez les personnes \u00e2g\u00e9es.<\/p>\n\n\n\n<p>Il existe d&#8217;autres \u00e9tiologies qu&#8217;il faut toujours rechercher :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>hypertonie vagale<\/li><li>hyperkali\u00e9mie<\/li><li>IDM<\/li><li>hypothyro\u00efdie<\/li><li>m\u00e9dicaments (antiarythmiques, morphine, psychotropes)<\/li><\/ul>\n\n\n\n<p>Des tachycardies supraventriculaires (fibrillation auriculaire, flutter et tachycardie atriale ectopique) y sont fr\u00e9quemment associ\u00e9es en raison d\u2019anomalies diffuses de conduction et d\u2019automatisme au sein des oreillettes (maladie rythmique de l\u2019oreillette ou \u00ab syndrome bradycardie-tachycardie \u00bb).<\/p>\n\n\n\n<p>Il s\u2019agit d\u2019un syndrome (\u00ab sick sinus syndrome \u00bb) dont les m\u00e9canismes en sont nombreux :<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"288\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/sss-1024x288.png\" alt=\"\" class=\"wp-image-208\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/sss-1024x288.png 1024w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/sss-300x84.png 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/sss-768x216.png 768w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/06\/sss.png 2046w\" sizes=\"auto, (max-width: 767px) 89vw, (max-width: 1000px) 54vw, (max-width: 1071px) 543px, 580px\" \/><\/figure>\n\n\n\n<p>C&#8217;est la cause la plus fr\u00e9quente de pose de pace-maker.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Bibliographie<\/h2>\n\n\n\n<p>Ferrer MI. The Sick Sinus Syndrome. Circulation. 1973 Mar;47(3):635\u201341.<\/p>\n\n\n\n<p>Da Costa D. ABC of clinical electrocardiography: Bradycardias and atrioventricular conduction block. BMJ. 2002 Mar 2;324(7336):535\u20138.        <\/p>\n\n\n\n<p>Walsh-Irwin C, Hannibal GB. Sick Sinus Syndrome: AACN Advanced Critical Care. 2015;26(4):376\u201380.<\/p>\n\n\n\n<p>De Ponti R, Marazzato J, Bagliani G, Leonelli FM, Padeletti L. Sick Sinus Syndrome. Cardiac Electrophysiology Clinics. 2018 Jun;10(2):183\u201395.<\/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\/sinus-node-dysfunction-sick-sinus-syndrome\/\n<\/div><\/figure>\n","protected":false},"excerpt":{"rendered":"<p>Interpr\u00e9tation R\u00e9glages normaux Activit\u00e9 atriale d\u00e9sordonn\u00e9e dessinant un &#8220;toit d&#8217;usine&#8221; en V1 et V2 \u00e0 une cadence de 300bpm QRS fins, cadence ventriculaire lente \u00e0 36bpm QTc=500ms Onde T n\u00e9gative dans les d\u00e9rivations lat\u00e9rales (V4-V6) avec discret sous d\u00e9calage La pr\u00e9sence d&#8217;une bradycardie extr\u00eame sans rythme d&#8217;\u00e9chappement doit vous faire \u00e9voquer le diagnostic de SSS &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/admsu.org\/w\/ecg-n6-reponse\/\" class=\"more-link\">Continuer la lecture<span class=\"screen-reader-text\"> de &laquo;&nbsp;ECG n\u00b06 &#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":[36,37,38,35],"class_list":["post-205","post","type-post","status-publish","format-standard","hentry","category-ecg-commente","tag-bradycardie","tag-ecg-commente","tag-flutter","tag-sss"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/205","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=205"}],"version-history":[{"count":1,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/205\/revisions"}],"predecessor-version":[{"id":209,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/205\/revisions\/209"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=205"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=205"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=205"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}