Download - Td ecg dr saadi (diapo)
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ELECTROCARDIOGRAMMETD physiologie cardiaque
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I/ définition
II/ rappel physiologique
III/ dérivations
IV/ enregistrement de l’ECG
V/ description et interprétation
VI/ conduite pratique
VII/ épreuve d’effort
VIII/ quelques anomalies de l’ECG
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DÉFINITION
-L’ECG correspond à l’enregistrement de l’activité électrique du cœur
-Investigation simple facilenon invasiveindolore
-cette activité électrique provient des fibres myocardiques et elle suit les principes de l’électrophysiologie
-l’ECG enregistre les variations du potentiel électrique entre 2 points éloignés de la surface du corps
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RAPPEL DE PHYSIOLOGIE
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Dipôle
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Lorsque le courant se dirige vers l’électrode on enregistre une onde positiveLorsque le courant s’éloigne on enregistre une onde négativeOn peut enregistrer une onde diphasique
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� L’ECG : enregistrement de la somme de tous les PA qui se propagent dans le coeur
� L’activité électrique du cœur est la somme de l’activité électrique de toutes les cellules myocardiques , chacune se comportant comme un dipôle ( pôle positif et pôle négatif ).
l’activité électrique du cœur = ensemble de dipôles
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III/ LES DÉRIVATIONS
� L’ECG représente les variations de potentiel entre 2 électrodes dont l’une est placée à la borne positive , l’autre à la borne négative
� La disposition sur le corps de 2 électrodes s’appelle : dérivation
peuvent être : unipolaires
bipolaires
deux type de dérivation :
périphériques
précordiales
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Dérivations unipolaires
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Dérivations bipolaires
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Découvreur de l’électrocardiogramme
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V1 : 4ème EIC bord droit du sternumV2: 4ème EIC bord gauche du sternum ( face V1)V4 : ligne médioclaviculaire 5EIC sous le mamelon gaucheV3 : mi distance entre V2 et V4V5 : ligne axillaire ant même niveau que V4V6 : ligne médiane axillaire même niveau que V4 ,V5
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� Au total L’ECG comprend 12 dérivations
6 dérivations périphériques
3 unipolaires : AVR – AVF – AVL
3 bipolaires : DI – DII – DIII
6 dérivations précordiales
6 unipolaires : V1, V2, V3, V4, V5 , V6
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TRIANGLE D’EINTHOVEN
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TRIANGLE D’EINTHOVEN WILSON
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DOUBLE TRIAXE DE BAILEY
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IV/ ENREGISTREMENT DE L’ECG
� Matériels
appareil de l’ECG
électrodes périphériques
électrodes précordiales
gel électrolytique
� Pratique de l’enregistrement
� ECG sur papier millimétré déroulé à une vitesse de 25 mm/ seconde donc 1 mm = 0,04 s
� vérification de l’amplitude : 1Mv corresponde
� à 10 mm
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V/ DESCRIPTION ET INTERPRÉTATION DE
L’ECG
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LA DÉPOLARISATION ATRIALE :ONDE P
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� Onde P
dépolarisation auriculaire
dure moins de 0,12 s ( 3 pt carreaux )
amplitude moins de 2,5 mm
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JONCTION AURICULOVENTRICULAIRE : ESPACE
PR
L’espace PR entre le début de l’onde P et le début de dépolarisation ventriculaireDure entre 0,12 –0,20 s ( 3- 5 pt carreaux )
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V/ DESCRIPTION ET INTERPRÉTATION DE
L’ECG
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LA DÉPOLARISATION VENTRICULAIRE : COMPLEXE QRS
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REPOLARISATION VENTRICULAIRE :ONDE T
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VI/ CONDUITE PRATIQUE
� Interprétation de l’ECG
- éviter quelques pièges
- fréquence cardiaque
- axe du cœur
- rythme cardiaque
- onde P, espace PR ,complexe QRS ,
le segment ST ,onde T
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50 mm/S
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� Les 3 pièges à éviter sont :
l’étalonnage
parasitage
inversion des fils
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CALCUL DE LA FC SUR L’ECG
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RYTHME CARDIAQUE
- Régulier ou irrégulier
- Sinusal ou non sinusal
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L’AXE DU COEUR
Triaxe de bailey
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EXEMPLE :
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L’onde P : amplitude moins de 2 mmdurée : moins de 0,12 s ( 3 pt carreaux
L’espace PR :durée : 0,12- 0,20 s ( 3 à 5 pt carreaux
Complexe QRS:moins de 0,08 s ( 2 pt carreaux
Segment ST : isoélectrique
Onde T : ne doit pas être plus grande que la ½ du QRS
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QUELQUES EXEMPLES D’ANOMALIES
Tachycardie sinusale
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QUELQUES TESTS: DÉTERMINATION DE L’AXE
+90°
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Déviation axiale droite Axe : + 150°
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Axe = 0°
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DÉTERMINATION DU RYTHME
Bradycardie sinusale
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Arythmie sinusale
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Tachycardie sinusale
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Tachycardie régulière à QRS large = TV
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Inversion des fils onde P négative en DI,DII