Diagnostic ECG du syndrome coronarien aigu

Partie 2. Les anomalies de la repolarisation
Mise au Point / Update

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…).

Mots clés

Électrocardiogramme ECG Syndrome coronarien aigu Infarctus Diagnostic Bloc de branche Hypertrophie ventriculaire 

ECG for the diagnosis of acute coronary syndrome

Part 2. The repolarization abnormalities

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…).

Keywords

Electrocardiogram ECG Acute coronary syndrome Diagnosis Bundle-branch block Ventricular hypertrophy 

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Copyright information

© Société française de médecine d'urgence and Springer-Verlag France 2012

Authors and Affiliations

  1. 1.Service des urgences, hopital Saint-LouisAssistance publique-Hôpitaux de ParisParisFrance
  2. 2.Faculty Emergency Physician, Hennepin County Medical Center, Associate Professor of Emergency MedicineUniversity of Minnesota School of MedicineMinneapolisUSA
  3. 3.Emergency Medicine and MedicineUniversity of Virginia School of MedicineCharlottesvilleUSA

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