{"id":313,"date":"2019-08-20T10:00:27","date_gmt":"2019-08-20T08:00:27","guid":{"rendered":"https:\/\/admsu.org\/w\/?p=313"},"modified":"2019-08-17T02:33:49","modified_gmt":"2019-08-17T00:33:49","slug":"ecg-n13-reponse","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/ecg-n13-reponse\/","title":{"rendered":"ECG n\u00b013 &#8211; R\u00e9ponse"},"content":{"rendered":"\n<figure class=\"wp-block-embed-wordpress wp-block-embed is-type-wp-embed is-provider-admsu\"><div class=\"wp-block-embed__wrapper\">\nhttps:\/\/admsu.org\/w\/2019\/08\/09\/ecg-n13-question\/\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\">Interpr\u00e9tation<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Premier trac\u00e9<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Rythme sinusal et r\u00e9gulier<\/li><li>Espace PR &lt; 200ms<\/li><li>QRS fins<\/li><li>Sus d\u00e9calage du segment ST en lat\u00e9ral haut (DI, aVL) et ant\u00e9rieur (V2-V5) avec miroir en inf\u00e9rieur<\/li><\/ul>\n\n\n\n<p>=> STEMI ( ST Elevation Myocardial Infarction ) ant\u00e9rieur \u00e9tendu<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Second trac\u00e9<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Rythme r\u00e9gulier<\/li><li>Non sinusal, pas d&#8217;onde P visualis\u00e9e<\/li><li>QRS large<\/li><li>sus d\u00e9calage ST en lat\u00e9ral haut et sous d\u00e9calage inf\u00e9rieur<\/li><\/ul>\n\n\n\n<p>=> Rythme idio ventriculaire acc\u00e9l\u00e9r\u00e9<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pr\u00e9sentation &#8211; RIVA<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">D\u00e9finition<\/h3>\n\n\n\n<p>RIVA : Rythme Idio Ventriculaire Acc\u00e9l\u00e9r\u00e9<\/p>\n\n\n\n<p>C&#8217;est un rythme ventriculaire consistant en 3 complexes cons\u00e9cutifs ou plus, monomorphiques d&#8217;installation et de terminaison progressive.<\/p>\n\n\n\n<p style=\"text-align:left\">Ce rythme na\u00eet d&#8217;un foyer ventriculaire ectopique dont la cadence exc\u00e8de le rythme sinusal.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Signes ECG<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Un rythme r\u00e9gulier<\/li><li>Fr\u00e9quence comprise entre [50-110] Batt\/min, qui le diff\u00e9rencie :<ul><li>d&#8217;un \u00e9chappement ventriculaire plus lent &lt;50 batt\/Min<\/li><li>d&#8217;une tachycardie ventriculaire plus rapide >110 batt\/min<\/li><\/ul><\/li><li>Pr\u00e9sence de 3 ou plus complexes ventriculaires<\/li><li>Des QRS tr\u00e8s larges > 120 ms, d&#8217;axe \u00e9lectrique pouvant \u00eatre diff\u00e9rent des ECG ant\u00e9rieur selon la localisation du foyer ectopique<\/li><li>Pr\u00e9sence de complexes de fusion ou de capture\u00a0<\/li><li>Possible comp\u00e9tition entre les foyers sinusal et ectopiques, se traduisant par une alternance de rythme. Dans ce cas, fr\u00e9quemment dissociation atrio ventriculaire avec nombreuses captures sinusales.\u00a0<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">\u00c9tiologies<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>La plus fr\u00e9quente et de loin : phase de reperfusion d&#8217;un infarctus myocardique\u00a0<\/li><li>Beta sympathomim\u00e9tiques tels que l&#8217;Isoprenaline ou l&#8217;Adrenaline\u00a0<\/li><li>Iatrog\u00e8nes: Digoxine, Cocaine, certains anesth\u00e9siques volatiles (ex Desflurane)\u00a0<\/li><li>Troubles ioniques<\/li><li>Cardiomyopathie, pathologie cardiaque cong\u00e9nitale, myocardites<\/li><li>Retour de circulation apr\u00e8s l\u2019arr\u00eat cardiaque\u00a0<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Traitement<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Rythme b\u00e9nin ne n\u00e9cessitant aucune th\u00e9rapeutique sp\u00e9cifique<\/li><li>C\u00e8de spontan\u00e9ment<\/li><li>Se limiter au traitement de la cause<\/li><\/ul>\n\n\n\n<p>Sp\u00e9cificit\u00e9 96%, Sensibilit\u00e9 38% <\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Bibliographie<\/h2>\n\n\n\n<p>Gildea, Thomas. \u00ab\u00a0ECG Diagnosis: Accelerated Idioventricular Rhythm\u00a0\u00bb. <em>The Permanente Journal<\/em>, 2018. <a href=\"https:\/\/doi.org\/10.7812\/TPP\/17-173\">https:\/\/doi.org\/10.7812\/TPP\/17-173<\/a>.  R<\/p>\n\n\n\n<p>Riera ARP, Barros RB, de Sousa FD, Baranchuk A. Accelerated Idioventricular Rhythm: History and Chronology of the Main Discoveries. Indian Pacing and Electrophysiology Journal;2010; 10(1):40-48\u00a0 <\/p>\n\n\n\n<p><a href=\"https:\/\/litfl.com\/accelerated-idioventricular-rhythm-aivr\">https:\/\/litfl.com\/accelerated-idioventricular-rhythm-aivr<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.e-cardiogram.com\/ecg-lexique_alpha.php?terme_lex=r&amp;id_lex=366\">https:\/\/www.e-cardiogram.com\/ecg-lexique_alpha.php?terme_lex=r&amp;id_lex=366<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Interpr\u00e9tation Premier trac\u00e9 Rythme sinusal et r\u00e9gulier Espace PR &lt; 200ms QRS fins Sus d\u00e9calage du segment ST en lat\u00e9ral haut (DI, aVL) et ant\u00e9rieur (V2-V5) avec miroir en inf\u00e9rieur => STEMI ( ST Elevation Myocardial Infarction ) ant\u00e9rieur \u00e9tendu Second trac\u00e9 Rythme r\u00e9gulier Non sinusal, pas d&#8217;onde P visualis\u00e9e QRS large sus d\u00e9calage ST &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/admsu.org\/w\/ecg-n13-reponse\/\" class=\"more-link\">Continuer la lecture<span class=\"screen-reader-text\"> de &laquo;&nbsp;ECG n\u00b013 &#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":[6,74,75,7],"class_list":["post-313","post","type-post","status-publish","format-standard","hentry","category-ecg-commente","tag-infarctus","tag-riva","tag-rythle-idio-ventriculaire-accelere","tag-stemi"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/313","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=313"}],"version-history":[{"count":1,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/313\/revisions"}],"predecessor-version":[{"id":316,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/313\/revisions\/316"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=313"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=313"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=313"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}