{"id":268,"date":"2019-07-23T21:28:17","date_gmt":"2019-07-23T19:28:17","guid":{"rendered":"https:\/\/admsu.org\/w\/?p=268"},"modified":"2019-07-23T21:28:17","modified_gmt":"2019-07-23T19:28:17","slug":"ecg-n10-question-reponse","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/ecg-n10-question-reponse\/","title":{"rendered":"ECG n\u00b010 &#8211; Question\/R\u00e9ponse"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><a href=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/Question-1.jpg\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"525\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/Question-1-1024x525.jpg\" alt=\"\" class=\"wp-image-269\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/Question-1-1024x525.jpg 1024w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/Question-1-300x154.jpg 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/Question-1-768x394.jpg 768w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/Question-1.jpg 1600w\" sizes=\"auto, (max-width: 767px) 89vw, (max-width: 1000px) 54vw, (max-width: 1071px) 543px, 580px\" \/><\/a><figcaption>Propos\u00e9 par Anne-Sophie ERMEL<\/figcaption><\/figure>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-2.png\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"507\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-2-1024x507.png\" alt=\"\" class=\"wp-image-270\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-2-1024x507.png 1024w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-2-300x149.png 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-2-768x381.png 768w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/07\/R\u00e9ponse-2.png 1118w\" 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>Pas de r\u00e9glages identifi\u00e9s. C&#8217;est l&#8217;occasion de vous rappeler la n\u00e9cessit\u00e9 de v\u00e9rifier les r\u00e9glages. Ici la cadence ventriculaire est rapide &gt; 150bpm (ce qui pourrait correspondre \u00e0 une vitesse de d\u00e9filement trop lente), l&#8217;amplitude des QRS et des ondes T en ant\u00e9rieur pourrait \u00eatre sur\u00e9valu\u00e9 par un voltage trop haut.<\/li><li>Il est difficile d&#8217;identifier avec certitude l&#8217;activit\u00e9 atriale stimulant le ventricule. J&#8217;ai identifi\u00e9 sur ce trac\u00e9 2 ondes P potentielles (Fl\u00e8che rouge et Fl\u00e8che verte). Je ne pense pas qu&#8217;elles correspondent au m\u00eame auriculogramme. Il n&#8217;y a pas d&#8217;onde P r\u00e9trograde. Dans les deux cas nous avons affaires \u00e0 une trachycardie atriale, mais il existe peut \u00eatre une voie accessoire si l&#8217;on retient l&#8217;onde P indiqu\u00e9e par une fl\u00e8che rouge comme stimulant le ventricule mais il n&#8217;y a pas de syndrome de pr\u00e9-excitation. Il faudrait ralentir la FC pour mieux l&#8217;identifier, quoi que, c&#8217;est peut \u00eatre pas une bonne id\u00e9e vu la suite&#8230;<\/li><li>L&#8217;espace PR est ~80ms dans l&#8217;un ou l&#8217;autre cas<\/li><li>Les QRS sont fins mais leur amplitude varie d&#8217;un complexe \u00e0 l&#8217;autre, il faut \u00e9voquer une alternance \u00e9lectrique.<\/li><li>Il n&#8217;y a pas de trouble de repolarisation \u00e9vident<\/li><\/ul>\n\n\n\n<p>=> L&#8217;association tachycardie, alternance \u00e9lectrique (et rabotage des ondes R non pr\u00e9sent ici) doit vous faire suspecter une tamponnade : \u00e9chographie.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pr\u00e9sentation<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Triade de la tamponnade<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>QRS microvolt\u00e9s<\/li><li>Tachycardie<\/li><li>Alternance \u00e9lectrique<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Alternance \u00e9lectrique<\/h3>\n\n\n\n<p>C&#8217;est une succession de P-QRS-T dont l&#8217;amplitude varie en passant d&#8217;un voltage normal \u00e0 une amplitude diminu\u00e9e. <\/p>\n\n\n\n<p>Ce ph\u00e9nom\u00e8ne est li\u00e9 au mouvement pendulaire du c\u0153ur dans une cavit\u00e9 liquidienne. Il s&#8217;approche ou s&#8217;\u00e9loigne des \u00e9lectrodes, le signal \u00e9lectrique responsable de la systole est donc capt\u00e9 plus ou moins loin en fonction de sa position.<\/p>\n\n\n\n<p>Cette triade avec alternance \u00e9lectrique concernant le P-QRS-T est importante dans le diagnostic de tamponnade. Il existe en effet d&#8217;autres situations physiologiques et pathologiques dans les quelles seuls l&#8217;amplitude des QRS varie :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Mouvements importants de la cage thoracique<\/li><li>Pneumothorax \u00e9tendu<\/li><li>Bloc de branche intermittent, aberration de conduction<\/li><li>Big\u00e9minisme ventriculaire<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Bibliographie<\/h2>\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-findings-in-massive-pericardial-effusion\/\n<\/div><\/figure>\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>Mugmon M. Electrical alternans vs. pseudoelectrical alternans. Journal of Community Hospital Internal Medicine Perspectives. 2012 Jan;2(1):17610.<\/p>\n\n\n\n<p>Mathur AP, Saini A, Lucas BP, AlYousef T, Margeta B, Mba B. Diagnostic Accuracy Retrospectively of Electrocardiographic Findings and Cancer History for Tamponade in Patients Determined to Have Pericardial Effusion by Transthoracic Echocardiogram. The American Journal of Cardiology. 2013 Apr;111(7):1062\u20136.         <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Interpr\u00e9tation Pas de r\u00e9glages identifi\u00e9s. C&#8217;est l&#8217;occasion de vous rappeler la n\u00e9cessit\u00e9 de v\u00e9rifier les r\u00e9glages. Ici la cadence ventriculaire est rapide &gt; 150bpm (ce qui pourrait correspondre \u00e0 une vitesse de d\u00e9filement trop lente), l&#8217;amplitude des QRS et des ondes T en ant\u00e9rieur pourrait \u00eatre sur\u00e9valu\u00e9 par un voltage trop haut. Il est difficile &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/admsu.org\/w\/ecg-n10-question-reponse\/\" class=\"more-link\">Continuer la lecture<span class=\"screen-reader-text\"> de &laquo;&nbsp;ECG n\u00b010 &#8211; Question\/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":[62,37,63,32],"class_list":["post-268","post","type-post","status-publish","format-standard","hentry","category-ecg-commente","tag-alernance-electrique","tag-ecg-commente","tag-swinging-heart","tag-tamponnade"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/268","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=268"}],"version-history":[{"count":1,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/268\/revisions"}],"predecessor-version":[{"id":271,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/268\/revisions\/271"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=268"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=268"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=268"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}