ECG

JOUER

BANQUE A ECGDUSMUR BMPM

Clinique non fournie

ECG normal

BBG + ST+

BBG simple

1

Présence des critères de Sgarbossa, signant un ST+ malgré le BBG

ECG normal

BBG + ST+

BBG simple

1

SCA ST+ avec BBG

• Destination = coro
• Coro = IVA

Cliquez pour accéder au site e-cardiogram.com

• Homme de 39ans. ATCD : Tabac actif 2 paquets/jour

• HDLM : douleur tho type brulure isolée, spontanément résolutive 2j auparavant. Récidive la veille, EVA 3/10. Consult au cab.

• TNT : disparition de la douleur. Pas de douleur à l’arrivée du SMUR

Pericardite

ECG normal

Syndrome de Wellens

2

• Homme de 39ans. ATCD : Tabac actif 2 paquets/jour

• HDLM : douleur tho type brulure isolée, spontanément résolutive 2j auparavant. Récidive la veille, EVA 3/10. Consult au cab.

• TNT : disparition de la douleur. Pas de douleur à l’arrivée du SMUR

Pericardite

ECG normal

Syndrome de Wellens

2

Wellens type 2

• Ancien « syndrome de menace de l’IVA »
• Destination = SIC ou coro selon les auteurs et les équipes
• Coro = IVA complète
• A noter, l’ECG présente des signes d’IDM récent (récidive)

Dans le syndrome de Wellens, la douleur est fluctuante et les modifications ECG sont volontiers en dehors des épisodes douloureux. Risque de mort subite !!

Cliquez pour accéder au site e-cardiogram.com

Clinique : douleur thoracique typique

STEMI (OMI)

Repolarisation précoce

ECG normal

3

STEMI (OMI)

Repolarisation précoce

ECG normal

3

Clinique : douleur thoracique typique

Quelques minutes plus tard....

3

Toujours prépositionner les patchs de défibrillation dans les St+...

STEMI inférieur (OMI)

• Onde de Pardee en inférieur
• Aspect d'ondes T hyperamples ischémiques V3-V4-V5
• "Hyperacute T waves"

• On remarque aussi un BAV 1
• Evolution vers TV/FV

Cliquez pour accéder au site e-cardiogram.com

Femme, 82ans, cancer du sein. HAD avec IDE. Somnolente, TA 7/4, SaO2 90%AA

STEMI (OMI)

Hyperkaliémie

ECG normal

4

Femme, 82ans, cancer du sein. HAD avec IDE. Somnolente, TA 7/4, SaO2 90%AA

STEMI (OMI)

Hyperkaliémie

ECG normal

4

Hyperkaliémie

• Dissociation A-V,
• BBD avec QSR en lames de sabre,
• QTc très allongé

L'aspect de l'ECG évolue rapidement en fonction de la kaliémie

Cliquez pour accéder au site e-cardiogram.com

Après 1 ampoule de gluconate de calcium

4

Changement de polarité des QRS en inférieur

Après une 2ième ampoule de gluconate de calcium

4

Réapparition de complexes normaux, raccourcissement QT

Après aérosols de Salbutamol

4

FC 68 avec QT normal, complexes réguliers

H 69a ATCD : Coronaropathie stentée 2009 + resténose 2012 // AAA ttt par endoprothese 2016 // AOMI // tabac // dyslipidémie Douleur de repos depuis 3 j cervicale et omoplate. Consulte MT ce jour : pouls et sat imprenable, appel SMUR G15, SaO2 imprenable puis 97% en AA par la suite HD = TA 98/60 et 81/45, 155, signes hypoperfusion periph, pouls radiaux et fémoraux non perçus Bdc reguliers, pas de souffle cardiaque franc ni abdo

TV

TSV

ECG normal

5

H 69a ATCD : Coronaropathie stentée 2009 + resténose 2012 // AAA ttt par endoprothese 2016 // AOMI // tabac // dyslipidémie Douleur de repos depuis 3 j cervicale et omoplate. Consulte MT ce jour : pouls et sat imprenable, appel SMUR G15, SaO2 imprenable puis 97% en AA par la suite HD = TA 98/60 et 81/45, 155, signes hypoperfusion periph, pouls radiaux et fémoraux non perçus Bdc reguliers, pas de souffle cardiaque franc ni abdo

TV

TSV

ECG normal

5

TV

• cf ci-contre
• VT score

Toute tachycardie régulière à QRS larges est une TV jusqu’à preuve du contraire

Cliquez pour accéder au site e-cardiogram.com

H 75a, troubles de la conscience, contexte de douleur tho depuis une semaineTA 8/6 // FC 132 // SaO2 95%

ECG normal

Hypokaliémie

Tamponnade

6

H 75a, troubles de la conscience, contexte de douleur tho depuis une semaineTA 8/6 // FC 132 // SaO2 95%

ECG normal

Hyperkaliémie

Tamponnade

6

Tamponnade

• Micro-voltage
• Alternance respiratoire de l’amplitude des QRS (D2 long)

Cliquez pour accéder au site e-cardiogram.com

H 35 ans, ECG de routine dans le cadre de son suivi

Equivalent ST+

ECG normal

WPW

7

H 35 ans, ECG de routine dans le cadre de son suivi

Equivalent ST+

ECG normal

WPW

7

ECG normal !Il parait que cela arrive...

H 35 ans, ECG de routine dans le cadre de son suivi

ECG normal

Repolarisation précoce

SCA ST +

8

Douleur thoracique typique

H 35 ans, ECG de routine dans le cadre de son suivi

ECG normal

Repolarisation précoce

SCA ST +

8

Douleur thoracique typique

Quelques minutes après...

8

SCA ST+

• SCA St+ (inféro-latero-basal)
• Destination = coro
• Importance d’anticiper la pose de patchs de défibrillation !

Homme de 41 ans, douleur thoracique typique

Onde J d'Osborn

ECG normal

SCA ST+

9

Homme de 41 ans, douleur thoracique typique

Onde J d'Osborn

ECG normal

SCA ST+

9

SCA ST+

• SCA St+ (inféro-latero-basal)
• Destination = coro

• Femme d'environ 40ans
• Retrouvée G6 au domicile
• Apyretique

SCA ST+

HSA

ECG normal

10

• Femme d'environ 40ans
• Retrouvée G6 au domicile
• Apyretique

SCA ST+

HSA

ECG normal

10

Tamponnade

• Tako-tsubo-like, ou cardiopathie neurogénique de stress
• Dans un contexte d’HSA (Fisher 4)
• Destination = rea
• Mauvais pronostic...
• Peut mimer des troubles du rythme, des troubles de la repolarisation...

Cliquez pour accéder au site e-cardiogram.com

Homme de 43 ans, douleur thoracique atypique depuis 1h

Hyperkaliémie

ECG normal

Tble du rythme + ST+

11

Homme de 43 ans, douleur thoracique atypique depuis 1h

Hyperkaliémie

ECG normal

Tble du rythme + ST+

11

STEMI avec BAV 2

• BAV 2, Möbitz 4:1, ischémique, sur St+ inférieur
• Destination = coro
• Coro = occlusion CD3

Cliquez pour accéder au site e-cardiogram.com

Homme de 73ans, malaise et douleur thoracique a 48h d'une échec de cryoablation de FA chez un patient porteur d'un DAI monochambre en prévention secondaire d'une coronaropâthie stentée et pontée.Le DAI est réglé en VVI à 60bpm

Syndrome du Pacemaker

ECG normal

STEMI

12

Homme de 73ans, malaise et douleur thoracique a 48h d'une échec de cryoablation de FA chez un patient porteur d'un DAI monochambre en prévention secondaire d'une coronaropathie stentée et pontée.Le DAI est réglé en VVI à 60bpm

Syndrome du Pacemaker

ECG normal

STEMI

12

Syndrome du pacemaker

• Dyspnée, palpitation, fatigabilité...
• Mecanisme :
• Activation rétrograde des oreillettes, juste après le ventricule

• La contraction atriale "tombe" sur valves fermées, explicant les symptômes

Cliquez pour accéder au site e-cardiogram.com

Douleur thoracique typique

BBG

ECG normal

Equivalent STEMI

13

Douleur thoracique typique

BBG

ECG normal

Equivalent STEMI

13

Equivalent ST+

• Plusieurs éléments sont visibles sur cet ECG :
• l'onde de De Winter (équivalent ST+)
• Le sus décalage en AVR

Ce patient présente une occlusion aigue (OMI).La coro montre une occlusion complète de l'IVA proximale

E-cardiogram.com : les équivalents ST+

E-cardiogram.com : l'onde de De Winter

Homme de 43ans, sans ATCD, qui présente une douleur tho avec irradiation dans le bras gauche + nausées au cours d'un effort physique modéré (chez son kiné)

HVG

ECG normal

Equivalent STEMI

14

Homme de 43ans, sans ATCD, qui présente une douleur tho avec irradiation dans le bras gauche + nausées au cours d'un effort physique modéré (chez son kiné)

HVG

ECG normal

Equivalent STEMI

14

Equivalent ST+

• Hyperacute T wave
• Ondes T hyper-amples, ischémiques
• > 75% du QRS
• Phase sur-aigue de l'occlusion coronaire

Epilogue : Cx proximale occluse

E-cardiogram.com : les équivalents ST+

82 ans, IRA dialysée, Rao et RM. Malaise, asthénie et sensation de douleur tho type brulure thoracique.

Hyperkaliémie

ECG normal

Equivalent STEMI

15

82 ans, IRA dialysée, Rao et RM. Malaise, asthénie et sensation de douleur tho type brulure thoracique.

Hyperkaliémie

ECG normal

Equivalent STEMI

15

D2 long

15

Hyperkaliémie

• Dissociation A-V,
• BBD avec QSR en lames de sabre
• QTc très allongé
• Destination : réa pour EER

L'aspect de l'ECG évolue rapidement en fonction de la kaliémie

Cliquez pour accéder au site e-cardiogram.com

Homme de 60ans

• Pas d’ATCD
• Angor d’effort depuis 1 semaine
• Tropo en ville = normale
• Reconsulte son MG pour aggravation de la douleur
• Douleur présente à l’arrivée (ECG 1), puis disparait (ECG 2, 3 et 4)

ECG normal

Syndrome de Wellens

HVG

16

Homme de 60ans

• Pas d’ATCD
• Angor d’effort depuis 1 semaine
• Tropo en ville = normale
• Reconsulte son MG pour aggravation de la douleur
• Douleur présente à l’arrivée (ECG 1), puis disparait (ECG 2, 3 et 4)

ECG normal

Syndrome de Wellens

HVG

16

Quelques minutes plus tard...

16

Wellens type 2

• Ancien « syndrome de menace de l’IVA »
• Destination = SIC ou coro selon les auteurs et les équipes
• Coro = IVA complète

Dans le syndrome de Wellens, la douleur est fluctuante et les modifications ECG sont volontiers en dehors des épisodes douloureux. Risque de mort subite !!

Cliquez pour accéder au site e-cardiogram.com

Femme 77ans

• ATCD : dialyse (dialysée la veille)
• Dyspnée, sueurs, jambes indurées

ECG normal

SCA ST+

Hyperkaliémie

17

Femme 77ans

• ATCD : dialyse (dialysée la veille)
• Dyspnée, sueurs, jambes indurées

ECG normal

SCA ST+

Hyperkaliémie

17

Hyperkaliémie

• Dissociation A-V,
• BBD avec QSR en lames de sabre
• QTc très allongé
• Destination : réa pour EER
• Bio : K+ = 10mmol/L...

Cliquez pour accéder au site e-cardiogram.com

Homme 70ans

• ATCD : Diabete, HTA
• Gène thoracique depuis 4h
• Epreuve d’effort negative
• Pas d’effet de la TNT

SCA ST+

ECG normal

HVG

18

Homme 70ans

• ATCD : Diabete, HTA
• Gène thoracique depuis 4h
• Epreuve d’effort negative
• Pas d’effet de la TNT

SCA ST+

ECG normal

HVG

18

SCA ST+ avec BBD

• SCA ST+ sur BBD (visible notamment en latéral)
• Onde T inversée = semi-récent
• Destination = Coro

Cliquez pour accéder au site e-cardiogram.com

Femme 30ans, feu d’appartement. G5, couverte de suie. SaO2 70% - SpCO 65%

Hyperkaliémie

ECG normal

Intoxication CO

19

Femme 30ans, feu d’appartement. G5, couverte de suie. SaO2 70% - SpCO 65%

Hyperkaliémie

ECG normal

Intoxication CO

19

Intoxication au CO

• Troubles de la repolarisation sur intoxication au CO
• NON SPECIFIQUE
• Destination = caisson hyperbare (même si St+ franc !)

Cliquez pour accéder au site e-cardiogram.com

Homme, 25 ans, palpitations sur le lieu de travail. Conscient mais inconfortable- FC 265, TA 11/6

TSV

TV

ECG normal

20

Homme, 25 ans, palpitations sur le lieu de travail. Conscient mais inconfortable- FC 265, TA 11/6

TSV

TV

ECG normal

20

TV infundibulaire

• Aspect de retard gauche non crochet
• Axe vertical ou droit (QRS positifs en D2-D3)
• BENIN !
• TRaitement : adénosine (ou BB- ou diltiazem)

Cliquez pour accéder au site e-cardiogram.com

Après 25mg de DILTIAZEM (TILDIEM)

20

26ans, surpoids, tabac, ATCD familial d'IDM (père). Douleur thoracique (constrictive) de repos, précordiale gauche irradiant dans le bras + 1 vomissement Episode similaire la veille, cédant spontanément après 20min. Cliniquement RAS.

STEMI

Myocardite

ECG normal

21

26ans, surpoids, tabac, ATCD familial d'IDM (père). Douleur thoracique (constrictive) de repos, précordiale gauche irradiant dans le bras + 1 vomissement Episode similaire la veille, cédant spontanément après 20min. Cliniquement RAS.

STEMI

Myocardite

ECG normal

21

Myo(péri)cardite

• En faveur d’une myocardite, on cherchera des signes de péricardite :
• Tachycardie,
• Sous-décalage de PQ en inférolatéral (ex DII et V4-V5),
• QRS non ou peu modifiés par l’ischémie
• Sus-décalage de ST plutôt non convexe et maximum en DII-V5 ou V4 > V3 > V2, sans miroir ou un miroir inapproprié
• Ratio ST/T en V6 > 25% de l’amplitude de R

Cliquez pour accéder au site e-cardiogram.com

- Femme, 60 ans, douleur thoracique atypique après effort ménagers - ATCD IDM père 40ans, AVC il y a 2 ans sans séquelles, surpoids, tabac

SCA ST+

ECG normal

HVG

22

- Femme, 60 ans, douleur thoracique atypique après effort ménagers - ATCD IDM père 40ans, AVC il y a 2 ans sans séquelles, surpoids, tabac

SCA ST+

ECG normal

HVG

22

SCA ST+

• SCA ST+ (aVr, V3R et V4R, miroir en inféro-lateral)
• Coro = Occlusion IVA1, et sub occlusion IVA2

Cliquez pour accéder au site e-cardiogram.com

- Femme, 75 ans - Retrouvée somnolente, TA 6/4 par l’IDE- Sous Aprovel, Cordarone, Temerit, Diamicron, Levothyrox, Kardegic - Bio la veille = Na 116 // K 5,1 // Creat 235

BAV 3

ECG normal

Intoxication

23

- Femme, 75 ans - Retrouvée somnolente, TA 6/4 par l’IDE- Sous Aprovel, Cordarone, Temerit, Diamicron, Levothyrox, Kardegic - Bio la veille = Na 116 // K 5,1 // Creat 235

BAV 3

ECG normal

Intoxication

23

Intoxication amiodarone

• Sur IRA
• Paralysie sinusale avec rythme jonctionnel
• Ondes P retrogrades,
• Bloc de Branche indéterminé,
• Allongement QT (QT 630ms, QTc 583ms)

• Repolarisation en « S » italique

Cliquez pour accéder au site e-cardiogram.com

Mise en place d’Isuprel, retour en rythme sinusal et FC a 45

23

Jeune patient - Prise de cocaine et d’héroine

Effet stab. membrane

ECG normal

SCA ST+

24

Jeune patient - Prise de cocaine et d’héroine

Effet stab. membrane

ECG normal

SCA ST+

24

Intoxication cocaine

• Toxicité multiple de la cocaïne
• Effet stabilisateur de membrane : visible ici
• Aspect de pseudo-brugada possible
• Tachycardie
• Spasme coronaire
• Authentique St+ possible

Cliquez pour accéder au site e-cardiogram.com

- Femme, 75ans, lupique sous Plaquénil - Douleur atypique, intense, au repos, depuis le matin, avec eructations et vomissements

RIVA

TV

ECG normal

25

- Femme, 75ans, lupique sous Plaquénil - Douleur atypique, intense, au repos, depuis le matin, avec eructations et vomissements

RIVA

TV

ECG normal

25

RIVA

• Rythme idio ventriculaire accéléré
• Sur SCA ST+

Cliquez pour accéder au site e-cardiogram.com

Homme de 55ans. Dyslipidémie, HTA, diabète. Douleur thoracique typique après un effort. Persistance de la douleur à l’arrive du SMUR

ECG normal

Equivalent ST+

FA

26

Homme de 55ans. Dyslipidémie, HTA, diabète. Douleur thoracique typique après un effort. Persistance de la douleur à l’arrive du SMUR

ECG normal

Equivalent ST+

FA

26

Equivalent ST+

• “South African flag sign” (SAFS)
• Signe du drapeau Sud-Africain
• Anomalies ECG dérivations non contiguës
• Occlusion Dg

Cliquez pour accéder au site e-cardiogram.com

Régul : Homme de 51ans. Coronaropathie stentée en 2015. Douleur thoracique typique spontanée depuis 1h. Sueurs d’après l’épouse

TV

TSV

BBG

27

Régul : Homme de 51ans. Coronaropathie stentée en 2015. Douleur thoracique typique spontanée depuis 1h. Sueurs d’après l’épouse

TV

TSV

BBG

27

TV

• Monomorphe
• Sur sequelle IDM

Cliquez pour accéder au site e-cardiogram.com

Merci à tous !

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight

• Visit the Analytics settings;
• Activate user tracking;
• Let the communication flow!

Use this space to add awesome interactivity. Include text, images, videos, tables, PDFs... even interactive questions!Premium tip: Get information on how your audience interacts with your creation:

Got an idea?

Here you can include a relevant fact to highlight

Here you can include a relevant fact to highlight