{"id":258,"date":"2019-07-22T15:29:28","date_gmt":"2019-07-22T13:29:28","guid":{"rendered":"https:\/\/admsu.org\/w\/?p=258"},"modified":"2019-07-22T15:30:46","modified_gmt":"2019-07-22T13:30:46","slug":"ecg-n8-reponse","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/ecg-n8-reponse\/","title":{"rendered":"ECG n\u00b08 &#8211; R\u00e9ponse"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><a href=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-1-1024x473.png\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"473\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-1-1024x473.png\" alt=\"\" class=\"wp-image-260\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-1-1024x473.png 1024w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-1-300x139.png 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-1-768x355.png 768w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-1.png 1119w\" sizes=\"auto, (max-width: 767px) 89vw, (max-width: 1000px) 54vw, (max-width: 1071px) 543px, 580px\" \/><\/a><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Interpr\u00e9tation<\/h2>\n\n\n\n<ul class=\"wp-block-list\"><li>Rythme r\u00e9gulier avec onde P pr\u00e9c\u00e9dant chaque QRS et onde P positive en D1 et aVF. Pour autant le rythme ventriculaire n&#8217;est pas sinusal, on le d\u00e9taille ensuite.<\/li><li>Espace PR &gt; 200ms<\/li><li>QRS \u00e9largis dans toutes les d\u00e9rivations avec une onde R de croissance initiale lente dans les d\u00e9rivations lat\u00e9rales plut\u00f4t \u00e9vocatrice d&#8217;un retard gauche<\/li><li>A la naissance de chaque QRS, on observe un spike (entour\u00e9 en rouge) signifiant une d\u00e9polarisation stimul\u00e9e.<\/li><li>Trouble de la repolarisation avec perte de discordance, en pr\u00e9sence de ce retard gauche, dans les d\u00e9rivations lat\u00e9rales, sus d\u00e9calage du segment ST en V4 (en jaune) et discordance pr\u00e9serv\u00e9e en V2-V3 mais segment ST sur\u00e9lev\u00e9 de plus de 5 mm (en vert).<\/li><\/ul>\n\n\n\n<p>=&gt; Probable SCA ST+ chez un patient \u00e9lectro entrain\u00e9.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pr\u00e9sentation &#8211; Bloc de branche gauche et syndrome coronarien aigu.<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Introduction<\/h3>\n\n\n\n<p>L&#8217;existence d&#8217;un bloc de branche gauche g\u00e8ne le diagnostic d&#8217;infarctus par modification importante de la d\u00e9polarisation. Le cas est le m\u00eame en pr\u00e9sence d&#8217;un entrainement \u00e9lectro systolique.<\/p>\n\n\n\n<p>La d\u00e9polarisation du VD pr\u00e9c\u00e8de celle du VG, laquelle se fait alors enti\u00e8rement de droite \u00e0 gauche. Dans une large majorit\u00e9 des cas, la sonde de stimulation d&#8217;un pacemaker \u00e0 l&#8217;\u00e9tage ventriculaire, se met en apical droit.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"488\" height=\"368\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/image.png\" alt=\"\" class=\"wp-image-262\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/image.png 488w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/image-300x226.png 300w\" sizes=\"auto, (max-width: 488px) 100vw, 488px\" \/><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Physiologie<\/h3>\n\n\n\n<p>En cas de bloc de branche, syndrome de pr\u00e9excitation, rythme ventriculaire, rythme \u00e9lectroentra\u00een\u00e9, et hypertrophie ventriculaire s\u00e9v\u00e8re, la discordance de polarit\u00e9 qui&nbsp;existe entre repolarisation et d\u00e9polarisation est appropri\u00e9e si :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>la d\u00e9viation du segment ST est oppos\u00e9e \u00e0 l\u2019orientation de la d\u00e9flexion principale du QRS (onde R ou onde S)<\/li><li>l&#8217;amplitude de la d\u00e9viation du segment ST est proportionnelle \u00e0 l\u2019amplitude du complexe QRS <\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Pathologie<\/h3>\n\n\n\n<p>Cette r\u00e8gle est \u00e0 l\u2019origine des <strong>crit\u00e8res des Sgarbossa<\/strong> pour la d\u00e9tection d\u2019un infarctus en cas de situation provoquant un retard de d\u00e9polarisation du ventricule gauche.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img loading=\"lazy\" decoding=\"async\" width=\"488\" height=\"812\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/Sgarbossa.png\" alt=\"\" class=\"wp-image-261\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/Sgarbossa.png 488w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/Sgarbossa-180x300.png 180w\" sizes=\"auto, (max-width: 488px) 100vw, 488px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Bibliographie<\/h2>\n\n\n\n<p>Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, et al. Third universal definition of myocardial infarction. European Heart Journal. 2012 Oct 1;33(20):2551\u201367.<\/p>\n\n\n\n<p>Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). European Heart Journal. 2019 Jan 14;40(3):237\u201369.<\/p>\n\n\n\n<p>Myriam Kaddour, Haran Burri. Diagnostic d\u2019un infarctus chez les patients porteurs d\u2019un stimulateur cardiaque. Rev Med Suisse 2018; volume 14.  1083-1088 <\/p>\n\n\n\n<p>Arnaud Naville, Arnaud Perrier. Diagnostic ECG de l\u2019infarctus en cas de bloc de branche gauche connu ou d\u2019entra\u00eenement ventriculaire. Rev Med Suisse 2013; volume 9. 1886-1891<\/p>\n\n\n\n<p><a href=\"https:\/\/www.e-cardiogram.com\/index.php\">https:\/\/www.e-cardiogram.com\/index.php<\/a><\/p>\n\n\n\n<p>                                                                             <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Interpr\u00e9tation Rythme r\u00e9gulier avec onde P pr\u00e9c\u00e9dant chaque QRS et onde P positive en D1 et aVF. Pour autant le rythme ventriculaire n&#8217;est pas sinusal, on le d\u00e9taille ensuite. Espace PR &gt; 200ms QRS \u00e9largis dans toutes les d\u00e9rivations avec une onde R de croissance initiale lente dans les d\u00e9rivations lat\u00e9rales plut\u00f4t \u00e9vocatrice d&#8217;un retard &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/admsu.org\/w\/ecg-n8-reponse\/\" class=\"more-link\">Continuer la lecture<span class=\"screen-reader-text\"> de &laquo;&nbsp;ECG n\u00b08 &#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":[57,37,6,59,61,60,13,7],"class_list":["post-258","post","type-post","status-publish","format-standard","hentry","category-ecg-commente","tag-bbg","tag-ecg-commente","tag-infarctus","tag-lbbb","tag-pacemaker","tag-sgarbossa","tag-st","tag-stemi"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/258","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=258"}],"version-history":[{"count":2,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/258\/revisions"}],"predecessor-version":[{"id":264,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/258\/revisions\/264"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=258"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=258"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=258"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}