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ELECTROELECTRO-- CARDI OGRAMMECARDI OGRAMMEELECTROELECTRO-- CARDI OGRAMMECARDI OGRAMME
Dr A.DJELLAOUDJIDr A.DJELLAOUDJIMaitre assistant en cardiologieMaitre assistant en cardiologie
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ECG NORMAL
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1- Ralisat ion d' un E. C. G2- I nt er prt at ion d' un E. C. G nor mal
.
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1- Ralisat ion d' un E. C. G
Llectrocardiogramme est l'enregistrement
sur papier des courants d'action cardiaque
transmis la surface du corps.
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Ralisat ion d' un E. C. G
Chaque lectrode capte les ondes
d'activation selon le plan du cur qu'elle
explore.
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Ralisat ion d' un E. C. G
Il existe 2 types de drivations :
Drivations standards (frontales)
Drivations prcordiales
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Ralisat ion d' un E. C. G
1/ Les drivations standards :
Les drivations bipolaires D1 : entre bras D (ple -) et bras G (+)
D2 : entre bras D (ple -) et jambe G (+)
D3 : entre bras G (ple -) et jambe G (+)
Les drivations unipolaires AVR : bras droit
AVL : bras gauche
AVF : la jambe gauche
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Ralisat ion d' un E. C. G
Lensemble des drivations uni
et bipolaires projetes
gomtriquement reprsentent
un double triaxe avec un centre
schmatique qui est le cur
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Ralisat ion d' un E. C. G
2/ Les drivations prcordiales :
V1 : 4me EICD, au bord droit du sternum. V2 : 4me EICG, au bord gauche du sternum. V3 : entre V2 et V4.
V4 : 5me EICG, sur la ligne mdioclaviculaire. V5 : 5me EICG, sur la ligne axillaire antrieure. V6 : 5me EICG, sur la ligne axillaire moyenne.
V7 : 5me EICG, sur la ligne axillaire postrieur V8 : 5me EICG, la pointe de lomoplate V9 : 5me EICG, sur la ligne scapulo-vertbrale
V3R : entre V1 et V4R. V4R : 5me EICD, sur la ligne mdio-claviculaire VE : pigastre
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I nt er prt at ion d' un E. C. Gnor mal
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Linterprtation dun ECG doit toujours
tenir compte des donns clinique dupatient
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Identit et date
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vitesse de droulement et talonnage
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Rythme cardiaque :
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Rythme cardiaque :
Lactivit cardiaque normal est sous la dpendance
du nud de Keith et Flack ( nud sinusal ) :
Chaque QRS est prcd dune onde P
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Rythme cardiaque :
Chaque QRS est prcd dune onde P
le rythme cardiaque est rgulier(les intervalles P-P ne variant pas de plus de 0,15 sec au repos)
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Frquence cardiaque :
1/ Rythme cardiaque1/ Rythme cardiaque
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Frquence cardiaque
En utilisant la rgle ECG :
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Frquence cardiaque
La mthode des 300 :
On visualise donc londe R qui concide autrait gras
On calcule le nombre des gros carrs les2 ondes R
On divise 300 / ce nombre = FC
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Frquence cardiaque
Autres mthodes :
- On visualise donc londe R qui concide autrait gras
- On compte chaque trait gras qui suit :300,150,100,75,60,50
- La FC correspond lendroit ou tombe londeR suivante .
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Axe de QRS:
1/ Rythme cardiaque1/ Rythme cardiaque
2/ Frquence cardiaque2/ Frquence cardiaque
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Axe de QRS:
La direction de laxe moyen de QRS (AQRS) dansLa direction de laxe moyen de QRS (AQRS) dansle plan frontal varie dele plan frontal varie de -- 3030 + 110 + 110
AQRSAQRS normalnormal :: --1010 +90 +90 AQRSAQRS gauchegauche :: --1010 --9090
AQRSAQRS droitdroit :: +90+90 +180 +180
AQRSAQRS hyperdroithyperdroit:: +180+180 --9090 ..
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Axe de QRS:
Deux principes simples pour le calcule de laxe deDeux principes simples pour le calcule de laxe deQRS :QRS :
11-- laxe delaxe de QRSQRS est perpendiculaireest perpendiculaire
la drivation nulle la drivation nulle22-- laxe delaxe de QRSQRS a la direction de laa la direction de la
drivation la plus ample.drivation la plus ample.
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Axe de QRS:
Exp 1:Exp 1:
LeLe QRSQRS le plus ample est celui de D2le plus ample est celui de D2
AA--QRS est en D2 (+60QRS est en D2 (+60) :) : normalnormal
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Axe de QRS:
Exp 3:Exp 3:
LeLe QRSQRS le plus ample est celui de D3le plus ample est celui de D3
AA--QRS est en D3 ( + 120QRS est en D3 ( + 120):): droitdroit
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Axe de QRS:
Exp 4:Exp 4:
LeLe QRSQRS le plus ample est celui de D1le plus ample est celui de D1
LeLe QRSQRS (biphasique) est celui de D2(biphasique) est celui de D2
AA--QRS est en AVL(QRS est en AVL( -- 3030):): gauche.gauche.
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Les territoires :
1/ Rythme cardiaque1/ Rythme cardiaque
2/ Frquence cardiaque2/ Frquence cardiaque
3/ Axe de QRS:3/ Axe de QRS:
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antro-septal apical latral baslatral haut
V7V7
V8V8
V9V9
anterieur tendu
infrieur postro basal
postrieur vrai
circonfrentielle
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Onde P :
1/ Rythme cardiaque1/ Rythme cardiaque
2/ Frquence cardiaque2/ Frquence cardiaque
3/ Axe de QRS:3/ Axe de QRS:
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Onde P :
nn Elle est londe de dpolarisationElle est londe de dpolarisationauriculaire.auriculaire.
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Onde P :
Elle est de formeElle est de forme arrondiearrondie
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Onde P :
ArrondieArrondie
ToujoursToujours positivepositive enen D1.D2.D1.D2. et enet en V5.V6V5.V6 ..
ToujoursToujours ngativengative enen AVR.AVR.
SI ngative enSI ngative en D1: inversion desD1: inversion des lctrodelctrode ouousitussitus inversusinversus
SI ngative enSI ngative en D2: rythmeD2: rythme retrograderetrograde
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Onde P :
ArrondieArrondie
positive en D1.D2. et en V5.V6 .positive en D1.D2. et en V5.V6 .
ngative en AVR.ngative en AVR.
Souvent diphasique en V1.V2.Souvent diphasique en V1.V2.
DureDure : < 0,12 sec en: < 0,12 sec en D2D2
AmplitudeAmplitude : < 2 mm en: < 2 mm en D2D2 ..
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Onde P: > 0,12 sec en0,12 sec en D2D2
HAGHAG
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Onde P : >2 mm en2 mm en D2D2 .. HADHAD
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intervalle PR :
1/ Rythme cardiaque1/ Rythme cardiaque
2/ Frquence cardiaque2/ Frquence cardiaque
3/ Axe de QRS3/ Axe de QRS
4/ Onde P4/ Onde P
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intervalle PR :
nn temps de conduction auriculotemps de conduction auriculo--ventriculaire.(ventriculaire.( intraintra--auriculaire,intraauriculaire,intra--nodalnodal et intraet intra--hissienhissien ))
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intervalle PR :
NB:NB: -- Chez les sujets vagotoniques rythme cardiaque < 60/mn, il est possibleChez les sujets vagotoniques rythme cardiaque < 60/mn, il est possibledobserver des [ ] PR allant jusqu 0,24 sec.dobserver des [ ] PR allant jusqu 0,24 sec.
-- Chez lenfant < 10 ans, l [ ] PR est plus court ( 0,10 et 0,17 s).Chez lenfant < 10 ans, l [ ] PR est plus court ( 0,10 et 0,17 s)...
Il se mesure de dbut l'onde P jusqu'au dbut du QRS .Il se mesure de dbut l'onde P jusqu'au dbut du QRS .
DureDure :: 0.12 0.200.12 0.20 secondeseconde
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intervalle PR :
DureDure :: > 0.200.20 secsec
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intervalle PR :
PrexitationPrexitation ventriculaireventriculaire
DureDure ::
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Complexe QRS :
1/ Rythme cardiaque1/ Rythme cardiaque
2/ Frquence cardiaque2/ Frquence cardiaque
3/ Axe de QRS3/ Axe de QRS
4/ Onde P4/ Onde P
5/ intervalle PR5/ intervalle PR
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Complexe QRS :
Il correspond lactivation et la dpolarisationIl correspond lactivation et la dpolarisationdes ventricules de ldes ventricules de lendocardeendocarde vers lvers lpicardepicarde,,
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Complexe QRS :
il est normalement constitu de trois segmentsil est normalement constitu de trois segments :: Londe QLonde Q : premire dflexion ngative: premire dflexion ngative prcdantprcdant
londe Rlonde R
Londe RLonde R : premire dflexion positive: premire dflexion positive
Londe SLonde S : dflexion ngative qui suit londe: dflexion ngative qui suit londe RR L'onde RL'onde R : deuxime dflexion positive: deuxime dflexion positive
Londe SLonde S : dflexion ngative qui suit londe R: dflexion ngative qui suit londe R
Londe QSLonde QS : dflexion ngative exclusive.: dflexion ngative exclusive.
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Complexe QRS :
La dure :La dure : varie de 0,06 0,10 secondevarie de 0,06 0,10 seconde
se mesure du dbut duse mesure du dbut du QRSQRSjusqu la fin de londejusqu la fin de londeS ou R, selon le cas )..S ou R, selon le cas )..
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Complexe QRS :
La dure :La dure : varie de 0,06 0,10 secondevarie de 0,06 0,10 seconde
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Complexe QRS :
La dure :La dure : > 0.12
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Complexe QRS :
Lamplitude :Lamplitude : se mesure en mm .se mesure en mm .
Par convention :Par convention :
Les ondes damplitudeLes ondes damplitude 5 mm5 mm scrit en minusculesscrit en minuscules :: q, r,q, r,s.s.
Les ondes damplitudeLes ondes damplitude > 5 mm> 5 mm scrit en majuscule :scrit en majuscule :Q,R,SQ,R,S
Cette convention permet de dcrire diffrents aspectsCette convention permet de dcrire diffrents aspects :: qRS,qRS,QrS, QS, RS, rSr .QrS, QS, RS, rSr .
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Complexe QRS :
Aspect dans les drivations prcordialesAspect dans les drivations prcordiales AspectAspect rSrS en V1.V2en V1.V2
AspectAspect qRsqRs en V5.V6en V5.V6
AspectAspect RSRS en V3.V4 :en V3.V4 : ( zone de transition ).( zone de transition ).
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Complexe QRS :
Aspect dans les drivations standardsAspect dans les drivations standards
La morphologie deLa morphologie de QRSQRS dans les drivations standardsdans les drivations standardsdpend de lorientation dedpend de lorientation de AxeAxe--QRS.QRS.
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Complexe QRS :
Indices dans les drivations prcordialesIndices dans les drivations prcordiales Un rapport R/S :Un rapport R/S : > 1 en V1> 1 en V1 HVDHVD
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Complexe QRS :
Indices dans les drivations prcordialesIndices dans les drivations prcordiales Lindice deLindice de SokolowSokolow--Lyon :Lyon : ( S en V1 + R en V5 ou en V6 )( S en V1 + R en V5 ou en V6 )
< 35 mm chez la femme >15 ans et chez lhomme >50 ans< 35 mm chez la femme >15 ans et chez lhomme >50 ans
< 40 mm chez la femme
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Complexe QRS :
Indices dans les drivations prcordialesIndices dans les drivations prcordiales Lindice deLindice de cornelcornel :: ( S en V3 + R en AVL)( S en V3 + R en AVL)
chez la femme < 20 mmchez la femme < 20 mm
chez lhomme < 28 mmchez lhomme < 28 mm
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Complexe QRS :
DflexionDflexion intrinscoideintrinscoide
elle exprime le temps que met londe de dpolarisation elle exprime le temps que met londe de dpolarisation parcourir le myocarde de lendocarde lparcourir le myocarde de lendocarde lpicardepicarde..
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Complexe QRS :
DflexionDflexion intrinscoideintrinscoide
Elle se mesure de du dbut deElle se mesure de du dbut de londe Qlonde Q au sommet deau sommet de londelondeR ou rR ou r, ou du dernier, ou du dernier crochetage de Rcrochetage de R si londe R estsi londe R estcrochete.crochete.
Sa valeur est de :Sa valeur est de : 0.03 sec en V10.03 sec en V1 : pour le VD: pour le VD
0.05 sec en V60.05 sec en V6 : pour le VG.: pour le VG.
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7/ Segment ST :
1/ Rythme cardiaque1/ Rythme cardiaque
2/ Frquence cardiaque2/ Frquence cardiaque
3/ Axe de QRS3/ Axe de QRS
4/ Onde P4/ Onde P
5/ intervalle PR5/ intervalle PR6/ Complexe QRS6/ Complexe QRS
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Segment ST :
nn Il correspond la priode dexcitation uniformeIl correspond la priode dexcitation uniformedes ventricules jusqu la phase de rcupration .des ventricules jusqu la phase de rcupration .
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Segment ST :
On le mesure de la fin deOn le mesure de la fin de londe S ou Rlonde S ou R (point J)(point J)jusquaujusquaudbut dedbut de londe T.londe T.
Il est isolectrique et horizontal ( parfois lgrementIl est isolectrique et horizontal ( parfois lgrementoblique )..oblique )..
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sous-dcalage de ST > 1mm ( standars)
> 2mm (prcordial) :
lsion sous-endocardique .
sus- dcalage de ST > 1mn :
lsion sous-picardique.
Segment ST :
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sous-dcalage de ST > 2mm (prcordial) :
lsion sous-endocardique .
Segment ST :
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sus- dcalage de ST > 1mn convexe : lsion sous-picardique.
Segment ST :
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sus- dcalage de ST > 1mn concave : syndrome derepolarisation prcoce
Segment ST :
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8/ Onde T :
1/ Rythme cardiaque1/ Rythme cardiaque
2/ Frquence cardiaque2/ Frquence cardiaque
3/ Axe de QRS3/ Axe de QRS
4/ Onde P4/ Onde P
5/ intervalle PR5/ intervalle PR
6/ Complexe QRS6/ Complexe QRS
7/ Segment ST7/ Segment ST
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Onde T :
C est la priode de repolarisationC est la priode de repolarisation
ventriculaireventriculaire
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Onde T :
Elle est asymtrique :Elle est asymtrique :-- branche ascendante lgrement obliquebranche ascendante lgrement oblique-- sommet +/sommet +/-- arrondiearrondie
-- branche descendante plus rapide.branche descendante plus rapide.
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Onde T :
Elle Peut tre (Elle Peut tre (--) en :) en : V1V1 V1 V4 (chez lenfant < 12ans).V1 V4 (chez lenfant < 12ans).
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11/ exemples
1/ Rythme cardiaque1/ Rythme cardiaque
2/ Frquence cardiaque2/ Frquence cardiaque
3/ Axe de QRS3/ Axe de QRS
4/ Onde P4/ Onde P
5/ intervalle PR5/ intervalle PR6/ Complexe QRS6/ Complexe QRS
7/ Segment ST7/ Segment ST
8/ Onde T8/ Onde T
9/ Onde U9/ Onde U
10/ Intervalle QT10/ Intervalle QT
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Merci
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Dr DJELLAOUDJI.AMaitre assistant en cardiologie
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1. auriculo-ventriculaire
2. intraventriculaire
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Blocs Auriculo-ventriculaires ( B.A.V.)
Les BAV sont des troubles du cheminement de l'activation sur la voie deconduction auriculo-ventriculaire
Siege :
soit dans le noeudd'Aschoff-Tawara
soit dans le troncdu faisceau de His
ou soit dans ses deux branches
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sont gnralement classs en 3 groupes:
Les BAV du 1er degr
Les BAV du 2me degr
Les BAV du 3me degr ou BAV Complets
B.A.V.
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Rhythm #10
60 bpm Rate?
Regularity? regular
normal
0.08 s
P waves?
PR interval? 0.36 s
QRS duration?Interpretation? 1st Degree AV B loc k
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BAV du 1er degr :
Ils se dfinissent par un ralentissement de la conduction auriculo-
ventriculaire.
B.A.V.
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BAV du 1er degr :
Sur le trac, cela se traduit par un allongement du PR au-del de 0,23
seconde.
B.A.V.
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BAV du 2me degr :
interruption intermittente de la conduction auriculo-ventriculaire,
B.A.V.
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Rhythm #11
50 bpm Rate?
Regularity? regularly irregular
nl, but 4th no QRS
0.08 s
P waves?
PR interval? lengthens
QRS duration?Interpretation? 2nd Degree AV B loc k, Type I
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BAV du 2me degr :
on distingue deux types:
Mobitz type I (Luciani-Wenckebach)
Mobitz type II
B.A.V.
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BAV du 2me degr :
Mobitz type I (Luciani-Wenckebach) :
allongement progressif du PR, jusqu la survenue dune onde P bloque.
Cette squence se rpte: ce sont les priodes de Luciani-Wenckebach.
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Rhythm #12
40 bpm Rate?
Regularity? regular
nl, 2 of 3 no QRS
0.08 s
P waves?
PR interval? 0.14 s
QRS duration?Interpretation?2nd Degree AV B loc k, Type II
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B.A.V.
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BAV du 2me degr :
Mobitz type II :
Sur le trac, on observe frquemment et rgulirement une onde P bloque.
L'intervalle PR reste constant.
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B.A.V.
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BAV du 2me degr :
Mobitz type II :
parfois on parle de BAV : 2 pour 1 ( 2/1 ): londe P est bloque 1 fois sur 2
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Rhythm #13
40 bpm Rate?
Regularity? regularno relation to QRS
wide (> 0.12 s)
P waves?
PR interval? none
QRS duration?Interpretation? 3rd Degree AV B lock
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BAV du 3me degr ou BAV Complets :absence complte de conduction entre les oreillettes et les ventricules.
On obtient une totale dissociation auriculo-ventriculaire.
v les oreillettes sont actives par un influx sinusal ou auriculaire.v les ventricules sont actives par un autre centre d'automatisme (soit lajonction, soit le rseau de Purkinje).
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BAV du 3me degr ou BAV Complets :
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1. auriculo-ventriculaire
2. intraventriculaire
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Conduction Normale
NS
NAV
F His
Les deux Branches
Fibers de Purkinje
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Blocs de branches
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Blocs de branches
RightBBB
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Les blocs intra ventriculaires ( Blocs de branches )
- Ils sont lis un retard de l'activation d'un ventricule par rapport l'autre,
- Par ralentissement ou par interruption de la conduction sur labranche droite ou sur la branche gauche.
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Les blocs intra ventriculaires ( Blocs de branches )
- Pour parler dun Blocs de branches , il faut 3 conditions:
1) rythme supraventriculaire (Sinusal, TA, ACFA, Flutter)
1) QRS 0.08 sec : BB incomplet
0.12 sec : BB complet
3) PR 0,12 seconde
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1/ Le bloc de branche droit : COMPLET (BBD)
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1/ Le bloc de branche droit : COMPLET (BBD)
v Prcordiales droite : V1.V2 Aspect : rR , rsR , rSR
( londe R : grande et large )
Troubles secondaires de la repolarisation :
Sous dcalage de ST
Onde T (-)
v Prcordiales gauche et D1.AVL:
Onde S large
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1/ Le bloc de branche droit : COMPLET (BBD)
Aspect rsR et QRS 0.12 sec
Troubles secondaires de la repolarisation Onde S large
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1/ Le bloc de branche droit : INCOMPLET (BID)
Aspect : rsr et QRS 0.08 - 0.12 sec
Troubles secondaires de la repolarisation
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1/ Le bloc de branche gauche : COMPLET (BBG)
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v Prcordiales gauche :V5.V6
Onde R exclusive avec :
Un pied empt ou crochet
Un sommet en plateau ( horizontal ou oblique ) parfois bifide ( en M ) ou
crochet .
Troubles secondaires de la repolarisation :
Sous dcalage de ST Onde T (-)
1/ Le bloc de branche gauche : COMPLET (BBG)
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v Prcordiales droite :V1.V2
Onde S large et profonde : rS ou QS
Troubles secondaires de la repolarisation : (image en miroir)
Sus dcalage de ST concave
Onde T (+)
1/ Le bloc de branche gauche : COMPLET (BBG)
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Onde R exclusive
sommet crochet
Troubles secondaires de la repolarisation
Onde S large et profonde : rS ou QS
Troubles secondaires de la repolarisation
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v Prcordiales gauche : Onde R exclusive avec :
emptement ou crochetage de la branche ascendante de londe R.
La repolarisation peut tre normale
Ou Troubles secondaires de la repolarisation :
Sous dcalage de ST
Onde T (-)
1/ Le bloc de branche gauche : INCOMPLET (BIG)
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v Prcordiales droite :
Onde S large et profonde : rS ou QS
Troubles secondaires de la repolarisation : (image en miroir)
Sus dcalage de ST
Onde T (+) /
1/ Le bloc de branche gauche : INCOMPLET (BIG)
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1- troubles du rythme sinusals2- troubles du rythme auriculairs
3- troubles du rythme nodals
4- troubles du rythme ventriculairs
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Rhythm #1
30 bpm Rate?
Regularity? regularnormal
0.10 s
P waves?
PR interval? 0.12 s
QRS duration?Interpretation? Sinus Bradycardia
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1/ La bradycardie sinusale
Cest un rythme sinusal rgulier de frquence infrieure 60/min.
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Rhythm #2
130 bpm Rate?
Regularity? regularnormal
0.08 s
P waves?
PR interval? 0.16 s
QRS duration?Interpretation? Sinus Tachycardia
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2/ La tachycardie sinusale Cest un rythme sinusal rgulier de frquence suprieure 100/ mn
chez l'adulte, avec des complexes QRS fins.
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Les extrasystolescontraction cardiaque prmatur dont le foyer dorigine est
ectopique.
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Rhythm #3
70 bpm Rate?
Regularity? occasionally irreg.2/7 different contour
0.08 s
P waves?
PR interval? 0.14 s (except 2/7)
QRS duration?Interpretation?NSR with Premature Atr ial
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1/ Lextrasystole auriculaire ( ESA )
onde P prmature de morphologie
diffrente de londe P sinusale
( elle peut tre visible ou confondue dans
londe T prcdente : onde T dforme ).
PR : normal
QRS : fins
avec souvent un Repos compensateurpost-extrasystole
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Les ESA peuvent tre : Isoles
Couplet ( doublet, triplet ou en salve) bigmines, trigmines ou quadrigmines
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Extrasystole jonctionnelle
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Les ESJ peuvent tre :
Isoles
Couplet ( doublet, triplet ou en salve)
bigmines, trigmines ou quadrigmines
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Lextrasystole ventriculaire : ESVLextrasystole ventriculaire : ESV
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Rhythm #4
60 bpm Rate?
Regularity? occasionally irreg.none for 7th QRS
0.08 s (7th wide)
P waves?
PR interval? 0.14 s
QRS duration?Interpretation?Sinus Rhythm with 1 PVC
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Lextrasystole ventriculaire : ESVLextrasystole ventriculaire : ESV
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yy
QRSQRS : Prmatur non prcd donde P: Prmatur non prcd donde P
large 0.12 seclarge 0.12 sec
Onde TOnde T toujours oppose au sens de QRStoujours oppose au sens de QRS
onde Ponde P rtrograde peut survenir avant , aprs, ou dans le QRSrtrograde peut survenir avant , aprs, ou dans le QRS
Elle est toujours ngative en D2.D3.AVF.Elle est toujours ngative en D2.D3.AVF.
PRPR :: 0.12 SEC0.12 SEC
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Les ESV : peuvent tre interpoles
Ou le plus souvent avec repos post-extrasystole :
compensateur (complet)ou
non compensateur (incomplet)
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Les ESV peuvent tre :
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Les ESV peuvent tre :
Isoles
Couplet ( doublet,
triplet ou en salve)
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Les ESV peuvent tre Rptitives :
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Les ESV peuvent tre Rptitives :
bigmines
trigmines
quadrigmines
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p
Monomorphes
polymorphes
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Les ESV peuvent tre :
De type R/T
RRTT
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1) troubles du rythme sinusals2) Les extrasystoles
3) troubles du rythme auriculaires
4) troubles du rythme nodales
5) troubles du rythme ventriculaires
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Rh h #6
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Rhythm #6
70 bpm Rate?
Regularity? regularflutter waves
0.06 s
P waves?
PR interval? none
QRS duration?Interpretation? Atrial Flutter
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2/ L fl i l i
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2/ Le flutter auriculaire Les ondes P sont remplaces par des ondes auriculaires anormales
dites ondes F. Les ondes F sont rgulires, identiques, en dents de scie, ngatives
en D2.
Leur frquence est rapide autour de 300/mn. La conduction peut tre de 3 ondes F pour 1 QRS (3/1),
2 ondes F pour 1 QRS ( 2/1) ,
1 ondes F pour 1 QRS ( 1/1) etc
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Rh th #5
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Rhythm #5
100 bpm Rate?
Regularity? irregularly irregularnone
0.06 s
P waves?
PR interval? none
QRS duration?Interpretation? Atrial Fibri l lat ion
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3/ La fibrillation auriculaire (FA)
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3/ La fibrillation auriculaire (FA) La frquence des ondes fest de 400 600/mn.
La rponse ventriculaire est irrgulire, avec des complexes QRSirrguliers et inquidistants avec une fqce de 56 105/mn.
Fibrillaton auriculaire sur imprgnation digitalique.
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1) troubles du rythme sinusals2) Les extrasystoles
3) troubles du rythme auriculaires
4) troubles du rythme nodales
5) troubles du rythme ventriculaires
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1) RYTHME JONCTIONNEL
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1) RYTHME JONCTIONNEL
Le rythme est dit jonctionnel lorsque l'activit lectrique du cur est gnre parle nud atrio-ventriculaire.
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1) RYTHME JONCTIONNEL
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1) RYTHME JONCTIONNEL
Ceci donne sur lECG :
des complexes QRS fins
sans ondes P le plus souvent.
Quelques fois, on observe aprs le complexe QRS une onde P dite rtrograde.
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2) Le syndrome de prexcitation et le Wolff
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2) Le syndrome de prexcitation et le Wolff
Parkinson White (W.P.W.)
dfinis par l'existence anormale d'une voie de conductionaccessoire qui court-circuite les voies normales deconduction.
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On distingue trois varits anatomiques de voiesaccessoires qui diffrent selon l'origine, le trajet, ou ladestination :
Le faisceau de Kent
Les fibres de James
Les fibres de Maham
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Une partie de limpulsion emprunte cette voie anatomique anormale
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Une partie de l impulsion emprunte cette voie anatomique anormalepour atteindre les ventricules,
mais ne subit plus le retard physiologique qu'engendre le NAV. Elleatteint donc plus rapidement les ventricules,
engendrant une activation anticipe appele prexcitationventriculaire.
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Sur le trac ECG
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Le syndrome de prexcitation (wpw) se traduit par :
un intervalle PR ! 0,12sec chez ladulte.
Une onde delta : prsente aupied de londe R, ralisent un
emptement dans la partie initiale
du QRS.
QRS largi
avec une morphologie de BBD ou de BBG
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1- troubles du rythme sinusals2- troubles du rythme auriculairs
3- troubles du rythme nodals
4- troubles du rythme ventriculairs
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Tachycardie ventriculaireTachycardie ventriculaire
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Tachycardie ventriculaire ( TV )
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Tachycardie ventriculaire ( TV )
La succession de plus de 3ESV une fqce > 100/mn avecdissociation auriculo-ventriculaire
La prsence de complexe de capture ( sinusal) et/ou de
complexe de fusion ( fusion de lactivation sinusale et
ectopique ) renforce le Dgc.
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Rythme idioventriculaire acclr
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Rythme idioventriculaire acclr
ils partagent les critres ECG de la tachycardie ventriculaire, Leur frquence est peu rapide, comprise entre 60 et 100/mn
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Torsade de pointe
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Torsade de pointe
varit de tachycardie ventriculaire polymorphe et non soutenue faite de complexes QRS largis, trs rapide, avec changement d'axe
lectrique.
Dure : quelques dizaines de secondes
Le plus souvent, se rduit spontanment, mais elle peut dgnrer enfibrillation ventriculaire.
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flutter ventriculaire
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Rythme ventriculaire trs rapide 250 / mn
Les QRS sont remplacs par des ondes de type sinusodal deforme et damplitude constantes
ce trouble du rythme dgnre rapidement en fibrillationventriculaire.
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Fibrillation ventriculaire ( FV )
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Rythme ventriculaire trs rapide fait doscillations irrgulire en
dure et en amplitude ralisant une activit ventriculaire
anarchique
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Asystolie ou trac plat
Activit lectrique sans pouls
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merci