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Electrocardiogramme:Quelle est votre interprétation?    Pascal SBRAGIA, Michaël Peyrol         CHU Nord - Marseille
Patient âgé de 64 ans, sansantécédent, consulte pour lipothymie           d’allure vagale       Quelle est votre interprét...
Analyse ECG• Ondes P négatives en DI = 3 possibilités:  1) Rythme ectopique atrial naissant de     l’oreillette gauche.  2...
1) Rythme ectopique atrial• NON car:   – Non seulement l’onde P est négative en DI mais le QRS et l’onde     T sont égalem...
2) Inversion d’électrodes• NON car:  – Malgré l’aspect d’inversion complète de l’onde    P, du QRS et de l’onde T compatib...
3) Situs inversus• OUI car:  – Autres possibilités éliminées.  – Aspect caractéristique en miroir de    toutes les dérivat...
Radiographie du thorax de face
Données générales• Le situs inversus complet est linversion complète de position  des viscères thoraciques et abdominaux (...
Solution  • Inverser toutes les électrodes.            FACEDroite                                         Gauche          ...
ECG du même patient avec les électrodes inversées     C’est mieux, non?
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Electrocardiogramme : quelle est votre interprétation ?

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Pascal Sbragia, Michel Peyrol - CHU Nord - Marseille

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Electrocardiogramme : quelle est votre interprétation ?

  1. 1. Electrocardiogramme:Quelle est votre interprétation? Pascal SBRAGIA, Michaël Peyrol CHU Nord - Marseille
  2. 2. Patient âgé de 64 ans, sansantécédent, consulte pour lipothymie d’allure vagale Quelle est votre interprétation?
  3. 3. Analyse ECG• Ondes P négatives en DI = 3 possibilités: 1) Rythme ectopique atrial naissant de l’oreillette gauche. 2) Inversion des électrodes (par l’externe de garde, très fréquent au CHU+++). 3) Situs inversus.
  4. 4. 1) Rythme ectopique atrial• NON car: – Non seulement l’onde P est négative en DI mais le QRS et l’onde T sont également inversés en DI ce qui est incompatible avec une dépolarisation physiologique des ventricules de droite à gauche sauf en cas de déviation axiale droite mais: – L’aspect rSr’ du QRS est incompatible avec une forte déviation axiale droite dont l’aspect est habituellement rS et ce d’autant que le patient n’a aucun antécédent particulier.
  5. 5. 2) Inversion d’électrodes• NON car: – Malgré l’aspect d’inversion complète de l’onde P, du QRS et de l’onde T compatible avec une inversion des électrodes entre les bras droit et gauche. – L’aspect ECG des dérivations précordiales parfaitement anormal est incompatible avec une activation ventriculaire physiologique et ne peut être expliquée par l’inversion d’électrodes frontales.
  6. 6. 3) Situs inversus• OUI car: – Autres possibilités éliminées. – Aspect caractéristique en miroir de toutes les dérivations frontales et précordiales.
  7. 7. Radiographie du thorax de face
  8. 8. Données générales• Le situs inversus complet est linversion complète de position des viscères thoraciques et abdominaux (et donc du cœur et des vaisseaux).• Transmission autosomique récessive.• La prévalence du situs inversus varie suivant les groupes de population, mais est inférieure à 1 sur 10.000 personnes.• Des mutations sur certains gènes ont été isolées, telles que les gènes DNAH5 (HL1), PCD ou encore CILD3.• Le situs inversus est présent chez 25% des patients porteurs du syndrome de Kartagener.
  9. 9. Solution • Inverser toutes les électrodes. FACEDroite Gauche V2 V1 V3 V6 V5 V4
  10. 10. ECG du même patient avec les électrodes inversées C’est mieux, non?

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