Résumé
Cette revue de la littérature met à jour les anomalies typiques de la repolarisation, mais aussi les anomalies subtiles et sous-estimées, de l’ischémie myocardique et de l’infarctus. Cette compilation explique la dynamique des changements lors d’une ischémie myocardique sévère (schématiquement, anomalies de l’onde T, puis du segment ST, puis du complexe QRS) et illustre en détail l’hétérogénéité des représentations ECG. Elle met l’accent sur l’importance de rechercher la moindre anomalie au sein de l’onde T (amplitude ou polarité non conforme au QRS, symétrie à la base), du segment ST (sus-décalage excessif, sous-décalage minime, perte de la discordance appropriée), mais également au sein des complexes QRS que l’ECG de base soit normal ou affecté par des anomalies fréquentes (hypertrophie, bloc de branche…).
Abstract
This review updates the clinician to the many typical, but also underappreciated and subtle, ECG signs of myocardial ischemia and infarction. This compilation explains the dynamic changes during severe myocardial ischemia (schematically, abnormal T-wave then ST-segment and QRS complex) and illustrates in detail the heterogeneity of the ECG representations. It emphasizes the importance of seeking any abnormality in the T-wave (amplitude or polarity not conforming to QRS, symmetry at the base), ST-segment (excessive elevation, minimal depression, or loss of appropriate discordance), but also within the QRS complex, to check whether the baseline ECG is normal or affected by frequent abnormalities (ventricular hypertrophy, bundle-branch block…).
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Taboulet, P., Smith, S.W. & Brady, W.J. Diagnostic ECG du syndrome coronarien aigu. Ann. Fr. Med. Urgence 3, 79–88 (2013). https://doi.org/10.1007/s13341-012-0272-z
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DOI: https://doi.org/10.1007/s13341-012-0272-z
Mots clés
- Électrocardiogramme
- ECG
- Syndrome coronarien aigu
- Infarctus
- Diagnostic
- Bloc de branche
- Hypertrophie ventriculaire