{"id":337,"date":"2019-08-27T22:47:06","date_gmt":"2019-08-27T20:47:06","guid":{"rendered":"https:\/\/admsu.org\/w\/?p=337"},"modified":"2019-08-27T22:47:06","modified_gmt":"2019-08-27T20:47:06","slug":"ecg-n14-reponse","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/ecg-n14-reponse\/","title":{"rendered":"ECG n\u00b014 &#8211; R\u00e9ponse"},"content":{"rendered":"\n<figure class=\"wp-block-image\"><a href=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-1.png\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"509\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-1-1024x509.png\" alt=\"\" class=\"wp-image-338\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-1-1024x509.png 1024w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-1-300x149.png 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-1-768x382.png 768w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-1.png 1400w\" 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>R\u00e9glages v\u00e9rifi\u00e9s, normaux<\/li><li>Tachycardie (difficile de savoir si r\u00e9guli\u00e8re ou non vu la rapidit\u00e9 de la cadence ventriculaire)<\/li><li>FC=180ms<\/li><li>QRS larges > 120ms dans toutes les d\u00e9rivations<\/li><li>Repolarisation ininterpr\u00e9table<\/li><\/ul>\n\n\n\n<p>=> Tachycardie \u00e0 QRS large<\/p>\n\n\n\n<p>Ce qui nous int\u00e9resse d\u00e9sormais est de connaitre la nature du rythme sous jacent. Le traitement n&#8217;est pas le m\u00eame et l&#8217;\u00e9volution n&#8217;est pas la m\u00eame.<\/p>\n\n\n\n<p>Il s&#8217;agit ici d&#8217;une tachycardie \u00e0 QRS large. Le premier \u00e9l\u00e9ment de l&#8217;algorithme de Vereckei est retrouv\u00e9 ici, \u00e0 savoir la pr\u00e9sence d&#8217;onde P ind\u00e9pendante des QRS (fl\u00e8che bleue). S&#8217;il vous est difficile de l&#8217;admettre, d\u00e9rouler l&#8217;ensemble de l\u2019algorithme confirmera cette hypoth\u00e8se.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Pr\u00e9sentation &#8211; Tachycardie \u00e0 QRS larges<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Irr\u00e9guli\u00e8res :<\/h3>\n\n\n\n<h4 class=\"wp-block-heading\">Fibrillation atriale + bloc de branche<\/h4>\n\n\n\n<ul class=\"wp-block-list\"><li>bloc de branche organique pr\u00e9 existant<\/li><li>bloc de branche fonctionnel : aberration de conduction ( l\u2019influx de d\u00e9polarisation supraventriculaire parvient dans une branche du faisceau de His encore en p\u00e9riode r\u00e9fractaire)<\/li><li>voie accessoire<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">R\u00e9guli\u00e8re<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>tachycardie atriale ou flutter avec bloc de branche<\/li><li>tachycardie jonctionnelle<ul><li>par r\u00e9entr\u00e9e intranodale<\/li><li>voie accessoire<\/li><\/ul><\/li><li>tachycardie ventriculaire<\/li><li>torsade de pointe<\/li><li>RIVA<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Algorithme<\/h3>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/www.sfmu.org\/upload\/70_formation\/02_eformation\/02_congres\/Urgences\/urgences2015\/donnees\/pdf\/010.pdf\"><img loading=\"lazy\" decoding=\"async\" width=\"611\" height=\"827\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-3.png\" alt=\"\" class=\"wp-image-340\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-3.png 611w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-3-222x300.png 222w\" sizes=\"auto, (max-width: 611px) 100vw, 611px\" \/><\/a><figcaption>SFMU 2015<\/figcaption><\/figure>\n\n\n\n<h3 class=\"wp-block-heading\">Traitements<\/h3>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-4.png\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"720\" src=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-4-1024x720.png\" alt=\"\" class=\"wp-image-341\" srcset=\"https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-4-1024x720.png 1024w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-4-300x211.png 300w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-4-768x540.png 768w, https:\/\/admsu.org\/w\/wp-content\/uploads\/2019\/08\/image-4.png 1250w\" 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\">Bibliographie<\/h2>\n\n\n\n<p>Vereckei A, Duray G, Szenasi G, Altemose GT, Miller JM. Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia. European Heart Journal. 28 nov 2006;28(5):589\u2011600.<\/p>\n\n\n\n<p>Brugada P, Brugada J, Mont L, Smeets J, Andries EW. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation. mai 1991;83(5):1649\u201159.<\/p>\n\n\n\n<p>Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, et al. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation. oct 2015;95:1\u201180.   <\/p>\n\n\n\n<p>SFMU 2015 &#8211; Les tachycardies \u00e0 QRS Larges     <\/p>\n","protected":false},"excerpt":{"rendered":"<p>Interpr\u00e9tation R\u00e9glages v\u00e9rifi\u00e9s, normaux Tachycardie (difficile de savoir si r\u00e9guli\u00e8re ou non vu la rapidit\u00e9 de la cadence ventriculaire) FC=180ms QRS larges > 120ms dans toutes les d\u00e9rivations Repolarisation ininterpr\u00e9table => Tachycardie \u00e0 QRS large Ce qui nous int\u00e9resse d\u00e9sormais est de connaitre la nature du rythme sous jacent. Le traitement n&#8217;est pas le m\u00eame &hellip; <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/admsu.org\/w\/ecg-n14-reponse\/\" class=\"more-link\">Continuer la lecture<span class=\"screen-reader-text\"> de &laquo;&nbsp;ECG n\u00b014 &#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":[1],"tags":[37,76,78,77],"class_list":["post-337","post","type-post","status-publish","format-standard","hentry","category-non-classe","tag-ecg-commente","tag-tachycardie-a-qrs-larges","tag-tachycardie-ventriculaire","tag-tv"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/337","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=337"}],"version-history":[{"count":1,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/337\/revisions"}],"predecessor-version":[{"id":342,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/337\/revisions\/342"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=337"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=337"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=337"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}