Résumé
Les signes ECG évocateurs d’un syndrome coronarien aigu reposent généralement sur l’analyse de la repolarisation. Néanmoins, les signes typiques peuvent manquer ou se dissimuler derrière une anomalie préexistante. Il est donc indispensable d’examiner aussi les complexes QRS, qu’ils soient fins ou larges, pour renforcer un diagnostic positif et préciser le stade de l’ischémie. Ces signes dynamiques sont au nombre de quatre: la distorsion terminale, la décroissance (rabotage) ou la croissance inappropriée des ondes R, l’apparition d’une onde Q et la fragmentation. Des équivalents existent en cas de bloc de branche. Chacun de ces signes apportent des renseignements sur le siège et la sévérité de l’ischémie, ce qui peut modifier la thérapeutique.
Abstract
ECG signs suggestive of acute coronary syndrome are generally based on the analysis of the repolarization. However, the typical signs can be missing or hidden behind a preexisting abnormality. Thus, is it essential to examine the QRS complexes, whether thin or large, to reinforce a positive diagnosis and specify the stage of ischemia. There are four dynamic signs: the terminal distortion, the absence or the inappropriate R-waves growth, the occurrence of new Q waves and the QRS-complexes fragmentation and their equivalents in case of bundle branch block. Each of these signs provide information on the territory and the severity of ischemia, which may influence the therapeutic.
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Taboulet, P., Smith, S.W. & Brady, W.J. Diagnostic ECG du syndrome coronarien aigu. Partie 3. Les anomalies des complexes QRS. Ann. Fr. Med. Urgence 3, 151–159 (2013). https://doi.org/10.1007/s13341-013-0279-5
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DOI: https://doi.org/10.1007/s13341-013-0279-5