Annales françaises de médecine d'urgence

, Volume 3, Issue 4, pp 240–247 | Cite as

Diagnostic ECG du syndrome coronarien aigu. Partie 4. Les diagnostics différentiels

Mise au Point / Update

Résumé

La constatation sur un électrocardiogramme d’une anomalie évocatrice d’un syndrome coronaire aigu doit conduire par prudence le clinicien à évoquer les diagnostics différentiels. À côté des variantes fréquentes de la normale et des anomalies secondaires de la repolarisation (bloc de branche, hypertrophie ventriculaire…), il faut évoquer des étiologies particulièrement trompeuses comme une ischémie fonctionnelle, une péricardite, un tako-tsubo, un anévrisme ventriculaire, une embolie pulmonaire, un syndrome de Brugada et d’autres anomalies (ex.: métaboliques, médicamenteuses, effet Chatterjee). Le propos de cette revue est d’aider le clinicien à distinguer ces diagnostics différentiels d’un syndrome coronaire aigu, grâce aux rappels de la description électrocardiographique des formes typiques et aux signes parfois subtils qui les distinguent d’une urgence coronaire.

Mots clés

Électrocardiogramme Syndrome coronarien aigu Péricardite Tako-tsubo Anévrisme ventriculaire Embolie pulmonaire Syndrome de Brugada 

ECG diagnosis of acute coronary syndrome. Part 4. The differential diagnoses

Abstract

The finding on ECG of abnormality suggestive of acute coronary syndrome should lead by caution the clinician to discuss the differential diagnoses. Besides the frequent abnormalities (e.g., normal variants, bundle branch block, and ventricular hypertrophy), we must mention etiologies particularly misleading as functional ischemia, pericarditis, tako-tsubo, ventricular aneurysm, pulmonary embolism, Brugada syndrome, and various other abnormalities (e.g., metabolic, drugs, and Chaterjee effect). The purpose of this review is to help the clinician to distinguish these differential diagnoses of acute coronary syndrome, with reminders of the electrocardiographic description of typical forms and sometimes subtle signs that distinguish them from coronary emergency.

Keywords

Electrocardiogram Acute coronary syndrome Pericarditis Tako-tsubo Heart aneurysm Pulmonary embolism Brugada syndrome 

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Copyright information

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

Authors and Affiliations

  1. 1.Service des urgences, hôpital Saint-LouisAssistance publique-hôpitaux de ParisParisFrance

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