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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 !!

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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

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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

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