{"id":280,"date":"2019-08-05T04:26:40","date_gmt":"2019-08-05T02:26:40","guid":{"rendered":"https:\/\/admsu.org\/w\/?p=280"},"modified":"2019-08-05T04:26:40","modified_gmt":"2019-08-05T02:26:40","slug":"ecg-n11-reponse","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/ecg-n11-reponse\/","title":{"rendered":"ECG n\u00b011 &#8211; R\u00e9ponse"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><a href=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/R\u00e9ponse.png\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"580\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/R\u00e9ponse-1024x580.png\" alt=\"\" class=\"wp-image-282\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/R\u00e9ponse-1024x580.png 1024w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/R\u00e9ponse-300x170.png 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/R\u00e9ponse-768x435.png 768w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/R\u00e9ponse.png 1201w\" 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 sinusal, irr\u00e9guliers, associant une onde P suivi d&#8217;un complexe QRS fin puis d&#8217;un QRS large dont la morphologie est variable sans activit\u00e9 atriale en amont, ne survenant pas sur l&#8217;onde T du complexe pr\u00e9c\u00e9dent.<\/li><li>FC=60bpm<\/li><li>Axe normal<\/li><li>Sous d\u00e9calage ST en inf\u00e9rieur (DII DII aVF) et ant\u00e9rieur (V2-V4), ST+ limite en aVL, isol\u00e9<\/li><\/ul>\n\n\n\n<p>=> Extrasystoles supraventriculaires, big\u00e9min\u00e9es, de morphologie variable, \u00e0 couplage normale sans ph\u00e9nom\u00e8ne R\/T.<\/p>\n\n\n\n<p>=> Devant les troubles de repolarisation associ\u00e9s, \u00e9tiologie isch\u00e9mique ? chatterjee ?<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pr\u00e9sentation<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Extra-systoles &#8211; crit\u00e8res de gravit\u00e9<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>> 10000 \/24h (chiffre difficile \u00e0 quantifier aux urgences), il faut \u00eatre vigilant s&#8217;il y a > 6\/min\u00a0 ou  >30\/H<\/li><li>ESV rapides (> 250 \/min)<\/li><li>Couplage court (RR &lt; 300ms) avec risque de ph\u00e9nom\u00e8ne R\/T<\/li><li>Polymorphismes des ESV <\/li><li>R\u00e9p\u00e9tition des ESV\u00a0: <ul><li>salves d&#8217;ESV = varie d&#8217;un auteur \u00e0 l&#8217;autre mais au moins > 3 successives<\/li><li>ESV soutenue > 30 sec = tachycardie ventriculaire<\/li><\/ul><\/li><li>Aggravation par l&#8217;effort<\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image.png\"><img loading=\"lazy\" decoding=\"async\" width=\"678\" height=\"429\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image.png\" alt=\"\" class=\"wp-image-283\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image.png 678w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-300x190.png 300w\" sizes=\"auto, (max-width: 678px) 100vw, 678px\" \/><\/a><figcaption>EHRA\/HRS\/APHRS Expert consensus on ventricular arrhythmias &#8211; ESC 2014<\/figcaption><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Effet Chatterjee<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">D\u00e9finition<\/h4>\n\n\n\n<p style=\"text-align:left\">L&#8217;effet Chartterjee ou m\u00e9moire cardiaque, est un trouble de la repolarisation ventriculaire secondaire a une d\u00e9polarisation anormale\u00a0 (BBG, un TV, WPW,stimulateur cardiaque, ou comme dans ce cas, une ESV) . <\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Physiopathologie<\/h4>\n\n\n\n<p>Ce ph\u00e9nom\u00e8ne est objectiv\u00e9 par des ondes T invers\u00e9es, transitoires et diffuses qui disparaissent apr\u00e8s quelques heures ou mois (variable selon la dur\u00e9e de l&#8217;anomalie initiale), en relation avec la lib\u00e9ration locale d\u2019Angiotensine II. De m\u00eame, plus la stimulation est prolong\u00e9e, plus l&#8217;onde T neg est profonde.<\/p>\n\n\n\n<p>Cet effet m\u00e9moire cardiaque est a conna\u00eetre car pro-arythmog\u00e8ne pouvant entrainer par lui m\u00eame des arythmies ventriculaires dangereuses.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">ECG<\/h4>\n\n\n\n<p>L&#8217;effet de Chartterjee se pr\u00e9sente sous forme d&#8217;ondes T invers\u00e9es dans le precordum\u00a0 mimant l&#8217;aspect\u00a0 qu&#8217;une isch\u00e9mie sous \u00e9picardique.<br>En cas d&#8217;h\u00e9sitation, entre un effet m\u00e9moire et un vrai trouble isch\u00e9mique, il faut chercher \u00e0 v\u00e9rifier la combinaison suivante (Sen=92%, Sp=100% pour un effet m\u00e9moire)\u00a0 propos\u00e9e par Shvilkin et col. :<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>onde T positive en DI<\/li><li>onde T positive ou iso-electrique en VL<\/li><li>onde T n\u00e9gative en pr\u00e9cordiale plus ample que l\u2019onde T n\u00e9gative en D3<\/li><li> patient electro-entrain\u00e9<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Bibliographie<\/h3>\n\n\n\n<p>Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, et al. EHRA\/HRS\/APHRS Expert Consensus on Ventricular Arrhythmias. Heart Rhythm. 2014 Oct;11(10):e166\u201396.        <\/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\/premature-ventricular-complex-pvc-ecg-library\/\n<\/div><\/figure>\n\n\n\n<p>Shvilkin A, Ho KKL, Rosen MR, Josephson ME. T-Vector Direction Differentiates Postpacing From Ischemic T-Wave Inversion in Precordial Leads. Circulation. 2005 Mar;111(8):969\u201374.        <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Interpr\u00e9tation Rythme sinusal, irr\u00e9guliers, associant une onde P suivi d&#8217;un complexe QRS fin puis d&#8217;un QRS large dont la morphologie est variable sans activit\u00e9 atriale en amont, ne survenant pas sur l&#8217;onde T du complexe pr\u00e9c\u00e9dent. FC=60bpm Axe normal Sous d\u00e9calage ST en inf\u00e9rieur (DII DII aVF) et ant\u00e9rieur (V2-V4), ST+ limite en aVL, isol\u00e9 &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/admsu.org\/w\/ecg-n11-reponse\/\" class=\"more-link\">Continuer la lecture<span class=\"screen-reader-text\"> de &laquo;&nbsp;ECG n\u00b011 &#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":[22],"tags":[65,37,67,66],"class_list":["post-280","post","type-post","status-publish","format-standard","hentry","category-ecmu-commente","tag-chatterjee","tag-ecg-commente","tag-extrasystoles","tag-pvc"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/280","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=280"}],"version-history":[{"count":1,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/280\/revisions"}],"predecessor-version":[{"id":284,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/280\/revisions\/284"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=280"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=280"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=280"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}