25mm/ s 1mm/ 40ms 5mms/ 200ms =1pet i tc ar r eau=1gr osc ar r e au1m mm m/ 0, 1mV 5m mm m 200ms ms; RR60100;P<120ms&<2, enD2;P60° ( D2 );PR120120ms ms 3 0 + 9 0 °( 3amp mpl QRS&<40ms; QRS80;QRSa VL a VF);Q <1/ 0m ms sà6 0bpm QT<44 ( d éb utQ >fi nT) Fqce =RR( 300150100756 050) T ac hy c ar di e( Fi br i l l at i on>350>Fl ut t er>250>T ac hy c ar di epar ox>150) >150TachyPar ox>250 T Aur i cul ai r eP ( ondesPv i s i bl es )≠T APa vecbl oc( 1/ 2P' d on neQRSDi g i t a l i q ue s/h KE) TJonct i onnel l eP=Bouver et( p asd ' o nd esP) =>=Tachy Supr aVent r i cul ai r e ( QRS<0 , 1 4)( c a l ma bl epa rma no eu v r ev a ga l e ) TVent r i cul ai r eP ( ESV)+/ -FV! ! =>=Tachy Vent r i cul ai r e ( QRS>0, 14)Dév°D,Di ss oc°AV( I Cor )ACONNAI TRE+++ =TACHY+QRSLar gesJ PDC:Nons out enue<30s< Sout enue >250Fl ut t er>350 FAur i cul ai r e =Dent sdesci enégat i ves=OndesFenD2D3AvF( ++déchar gesP>250/ 1QRS)( déma masquéma manoeuvr evagal e2/ 1>3/ 1) parr éent r éeAt r i um D>G =>I MPOSSI BLESI MAI LL ESAMP MPLES! ! FVent r i cul ai r e =s i nus oï dal ( c our t e>Fi br i l l at i onv ent r i c ul ai r e) ( c ar di ov er s i onenur genc e) >350Fi br i l l at i on>450 FAur i cul ai r e =t r émul at i onl i gnei s oél ec t r i que( ≠ondesP)=> fi l t r edonneQR QRSI r r eg +BAV=QRSl e nt si r r e g +Dy s f onc t i ons i nus al e( BSA)=al t er nanc ebr ady t ac hy ( «Mi edel ’ Or ei l l et t e»=«Mi er y t hmi queat r i al e») +BdB FVent r i cul ai r e =s ac sdev er s( pasd' ondePi dent i fi abl e)=>+/ ACR Br ady:c y cl e/6sx10
Ry t hmesi nus al =I RREGULI ER Fi br i l l at i onaur i cul ai r e T a c hyI r r e gQRSfi n s= ( ondesaur i c ul ai r es
er r at i ques=ondesf≠P) Ext r asyst ol eVent r i cul ai r e ( h KE,h O2 ,Mi eBa r l o w =p r o l a ps u sVa l v e mi t r al eparét i r ement )>3+/ -TV,>30s=s out enue Wander i ngPM :v ar i at i onf or meondesP<1002, 5 mm i nt e r v a l l eenD2=>1
25mV=HAD=> >2, 5mm ampl i t udeenD2OU>2, 0mm enV12=>0, «PGI DA» ocSi noAt r i al( a bs e nc e=Bl p au ses i n us al e+/ -r y t hmed ' é cha ppement 60aur i c ul ai r e>j onc t i onnel >40v ent r i c ul ai r e) 1° :pasvi s i bl eECG 2° :bl oc agepar o xy s t i quePPoudi mi nut i onpr ogr es s i fPPpui s bl oc age
3° :p au s e>3 s r asy st ol eAur i cul ai r e pr é mat u r é( =P' )+r ep osc o mpe ns at eu r=Ext ( hO2, a dr é ,B1 Ad r é,HTh y r ) =PR( c onduc t i onaur i c ul ov ent r i c ul ai r e) ocat r i ovent r i cul ai r e >0, 20=Bl ( SCA++,my oc ar di t es ,EI ,I at r o,HT oni e v agal e,HKE++,Lupus,SGS) 1° :Al l ongementfi x eetc ons t antPR>1gr andc ar r eau/5pet i t s c a r r e a u x 2° :Ce r t a i n esPs a n sQRS t zI= Augment at i onPRpr ogj usqu' àpasQRS=Mobi
WenckebachLuci ani ( 2/ 1augment éàmanoeuvr evagal e3/ 2)( QRSfins) t zI I( Ce r t a i n esPs a nsQRS( p ar o x y s t i q ue )=Mobi 2/ 1di mi nué àma no eu v r ev a ga l e1 / 1 )( QRS+/ -l a r g es ) 3° :di s s oc i at i onaur i c ul ov ent r i c ul ai r e=c ompl et Vent r i cul ai r e ( QRSl a r g es ) ( +/ -s y n c op eAd amsSt r o k es )<4 0< Jonct i onnel ( QRSfi ns ) <0, 12: Wol ffPar ki nsonWhi t e onde sDEL T A( =f ai s c eauac c es s oi r ede Kent>Réent r éeent r eHi s&Or ei l l et t e)( QRSl ongs ) SdduPRcour tLownGav onLev i ne Fl ut t er( =f ai sceaudeJames >a bs e nc efi l t r eNAV) i car di t e Sousdécal agePQ =Pér Pér i car di t e :Mi c r o v o l t a ge-Su sSTc o nc a v es a nsmi r o i r-So usPQ =>a pl a t tT-STi s oé l ec=>Tn ég at i v e s=>Re t o urnor mal e
T amponnade:T ac hy c ar di e/Mi c r o vol t age/Al t er nanc eél ec t r i que
Ax e =QRS( v ent r i c ul ai r e) QRSi s oél ec t r i quedansdév i at i onsf r ont al es( D1, 2, 3,Av R, F , L) ocdeBr anche >0, 8 0=Bl ( i nc ompl et=bi phas i que<0, 12)( c ompl et> 0, 12)=>HYPERTROPHI EVENTRI CULAI RENONI NTERPRdansG ( Ds i ! ) BBD =RSR' =M enV1V2/Rs R’ enV1 ( +/ -bén i n) =>AXE GAUCHE/ DROI T??? +r egar derenV1( +=BBD/-=BBG) BBG =RR' enV5V6/r SenV12 =>I DM NON I NTERPRET ABL E=SCAJ PDC ( Po s i t i fM/ Rs R' -d uc ô t éa t t e i n t ,r Sdel ' a ut r e c ôt é) =>Et i o:Co eu rPu l mo na i r e/p bVD/HKE/I a t r o( AD3 C) Hémi bl ocGauche d év i a t i onQRS= Ant é r i e ur = Ax eG +S3>S2Q1S2( axeG,I nf arant )
Pos t ér i eur=Ax eD+S1 Q3( a x eD,i nf a ri n f ) =>EP :T a c hy c a r d i es i n us a l e ,S1 Q3( Se nD1 &D3 ) ,BBD, Dév °Ax i al eD,T r ou bl er epo l °enAnt ,So usSTD2 Sy n d r o me s: Bl ocsBi f asci cul ai r es :BBD+( HBAG OUHBPG)( +/ -BAV) Bl ocsTr i f asci ul ai r es :Al t er nanceBBD/ G +HBA/ PG surf ondBBD =>Equi v al entBAV3! ! ! ! I n f ar c t us=o nd esQ /Sus So usST/i n v er s i o nT =ONDESQ =i s c hémi e( >1pe t i tc ar r e au/ >1/ 3QRS,>4 0ms≠BdB! ! ,>2 dér i v at i ons , )( phy s i oqenV5V6) =ST:>2 mm V1 6/>1mm a ut r e s/>/ =2dé r i v a t i o ns Sous ST=l é si onssous e nd oc a r d i q ue ( Epr euv ed' eff or t+)( Angor+EP)( +hKE,Di gi t al i ques( c upul e) Sus ST: Co nv e x e=l é s i o nss o usépi c ar di que( I DM,Pr i nz met al ) Conc av e=pér i c ar di t e omedeBr ugada Poi nt uV123:Syndr =ONDEST: <0=i s c h é mi es o usépi c ar di que+/ -mi r oi r( s idansV2V3=I VA= Syndr omedeWel l ens) g r a nd es=i s c h émi es ou sen do c ar d i q ue
LOCALI SATI ON=V12: =>( sousST&Q =Ant )≠( sus ST&R =Post ) Q enV123:Ant ér os ept al( I VA) V4:Ap i c a l SusSTe nV789/So usSTe nV12:Po s t é r i e ur=f ac eba sa l e&i nf ér i e ur VG ( Ar t è r eCo r o na i r eD) Q enD1Av L( haut )+V5V6( bas ):Lat ér al ( Ar t èr eCi r c onfl ex e) Qe nD2 3 Av F:I nf é r i e ur( Ar t è r eCo r o na i r eD>G)=>Ex t e ns i o nVD++= V1V2V3RV4R SEQUELLES=r abot t ementdesond esR
Conc ent r at i onél ec t r ol y t es=>T r i adedel amor thKE/HCaE/HDi gi t al i ques HKE:Pa pl a t i ,PRl o ng ,QRSé l a r g ie nl a med es ab r e ,Ta mp l e s ,TDRV => " T onampl ec on du i t ees tr y t hmé e" h KE:So usST ,QTl o ng ,Ap l a t tT ,On deU,TDRA/ V,Td P =>" T' a pl a t i sHu gh Gr an ts ousc et t eT or na de " HCa E:QTc ou r t( Cai n+ +) ,Ap l a t tT ,PRl o ng( BAV1 ) ,TDR =>" T aRa qu et t e Pl at epe r dl eRy t hme " h Ca E:QTl o ng( Cai n) Di gi t al i ques:c upul eSTdi gi t al i ne,s ousdéc al age/ <0Ts ousdéc al age+ r ac cour c i s sementQT( bl oc ss is ur c har ge,fi br i l l at i ons ii nt ox i c at i on) Qui ni di ne( Na/ K):( Pél ar gi c r oc het é,QRSél ar gi ,SousST ,QTal l ongé,OndeU s ii mpr égnat i on)( t or s adedepoi nt es ii nt ox i c at i on) TdP:FdR=Br ady/QTLong/hKE/hCaE;Cpl °=TV;TTT=st opmédoc FdR/Suppl °K+&Sul f at edeMgI V/I s upr énal i nes ibr ady/EES( VD)s ir éc i di v e p a u s e d ep =QT >0, 40:br ady ,hKE,hCaE,I at r o( qui ni di ne,AD3C,Ami odar one,Sot al ol , Bépr i di l ouhKE) ,Congéni t al ( +/ -s ur di t é)
Hy per t r ophi e=Sok ol o v t r ophi eaur i cul ai r e( Gr andeondePenV1:Hyper +>-=D,>+=G HT A, RM)( Di l at at i onAur i c ul ai r eD s i P>2 , 5d an sd ér i v a t i o nsd esme mbr e s ) R>SenV1,ondesSenV5V6per si st ant es,Ax eD,BdBD,OndeSen t r ophi event r i cul ai r eD D1D2D3=S1S2S3 :Hyper t r ophi event r i cul ai r eG S>R enV1,ondesRenV5,ondesTi nver sées:Hyper Sokol ov Mur phy=SV1( =SV1RV5>35mm)( 2+RV56<3 5mm)
Ti nv er s éV5V6: HVG Sy s t ol i que( =c onc ent r i quev er sl ’ i nt ér i eur -: RA,HTA,CMH=nonv ol umi nogéni que) ≠T+enV5V6: HVG Di as t ol i que( =ex c ent r i quev er sl ’ ex t ér i eur -:I A, I M,Ré t e nt i o nH2 ONa=v o l u mi n og én i q ue )
St i mul at i on =PM/ DAI=>REPOLARI SATI ONNONI NTERPRET ABLE=>T r opo/ Echo/Cor opourSCA PM =SPI KES St i mul at i onAur i c ul ai r e( =monoc hambr e) +/ -Ve nt r i c u l a i r e( Do ub l ec h amb r e )=>VDd ép ol a r i s éa v a ntBG =>BDB SECONDAI RE +/ -QRSe nt r a î n ése nmm t p s=fi n s( T r i p l ec ha mbr e ) DAI=ECG NORMAL! ! Mi c r ov ol t a ge :Amp l i t u de sde son de sd i mi n ué es Amy l o s e/Obé si t é/BPCO /Pér i c ar d i t eph as e1
