Diagnostic ECG du syndrome coronarien aigu. Partie 3. Les anomalies des complexes QRS

Mise au Point / Update

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.

Mots clés

Électrocardiogramme ECG Syndrome coronarien aigu Infarctus Diagnostic Bloc de branche Infarctus 

ECG for the diagnosis of acute coronary syndrome. Part 3. The QRS complexes abnormalities

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.

Keywords

Electrocardiogram ECG Acute coronary syndrome Diagnosis Bundle-branch block Myocardial infarction 

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Copyright information

© Société française de médecine d'urgence and Springer-Verlag France 2013

Authors and Affiliations

  1. 1.Hopital Saint-LouisAssistance publique-hôpitaux de ParisParisFrance
  2. 2.Faculty Emergency Physician, Hennepin County Medical CenterUniversity of Minnesota School of MedicineMinneapolisUSA
  3. 3.Emergency Medicine and MedicineUniversity of Virginia School of MedicineCharlottesvilleUSA

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