{"id":10091,"date":"2026-04-01T11:37:25","date_gmt":"2026-04-01T11:37:25","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10091"},"modified":"2026-04-01T11:37:25","modified_gmt":"2026-04-01T11:37:25","slug":"trace-3-2-bloc-de-branche-gauche-et-syncope","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-2-bloc-de-branche-gauche-et-syncope\/","title":{"rendered":"Trac\u00e9 3.2: Bloc de branche gauche et syncope"},"content":{"rendered":"","protected":false},"featured_media":10090,"template":"","ecg_case_type":[252],"language_ecgcase":[259],"class_list":["post-10091","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-bundle-branch-block","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 3.2: Bloc de branche gauche et syncope","patient_description":"Femme de 87 ans; hospitalisation \u00e0 la suite de 2 syncopes \u00e0 l\u2019emporte pi\u00e8ce","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) vrai(s) pour cet ECG?","quiz_answer_1":"rythme sinusal","quiz_answer_2":"hypertrophie auriculaire gauche","quiz_answer_3":"bloc de branche droit + h\u00e9mibloc ant\u00e9rieur gauche","quiz_answer_4":"bloc de branche gauche","quiz_answer_5":"bloc indiff\u00e9renci\u00e9","correct_answer":["A","B","D"],"ecg_image":10090,"ecg_description":"Rythme sinusal, hypertrophie auriculaire gauche (onde P \u00e9largie et fragment\u00e9e); bloc de branche gauche: largeur du QRS > 120 ms; absence d\u2019onde q et onde R large et crochet\u00e9e en DI, aVL, V5 et V6 avec retard de la d\u00e9flexion intrins\u00e9co\u00efde > 60 ms; aspect QS et rS en V1 et V2; sous-d\u00e9calage segment ST et onde T n\u00e9gative en DI, aVL, V5 et V6","ecg_info_box":"Les signes ECG d\u2019un bloc de branche gauche sont: un QRS large, un aspect caract\u00e9ristique en V6 (retard de la d\u00e9flexion intrins\u00e9co\u00efde, absence d\u2019onde q, positivit\u00e9s exclusives, sous-d\u00e9calage segment ST fr\u00e9quent), un aspect caract\u00e9ristique en V1 (pas de retard de la d\u00e9flexion intrins\u00e9co\u00efde, aspect rS ou QS). ","commentary_ecg":"Cette patiente pr\u00e9sente un aspect \u00e9lectrocardiographique caract\u00e9ristique de bloc de branche gauche qui associe :\r\n\r\n1. Un complexe QRS \u00e9largi \u00e0 120 ms ou plus chez l\u2019adulte, un QRS sup\u00e9rieur \u00e0 100 ms chez l\u2019enfant de moins de 8 ans ;\r\n\r\n2. Une apparition retard\u00e9e de la d\u00e9flexion intrins\u00e9co\u00efde sup\u00e9rieure \u00e0 60 ms (temps d\u2019activation ventriculaire pouvant aller jusqu\u2019\u00e0 100 ms) dans les d\u00e9rivations pr\u00e9cordiales gauches : elle est due \u00e0 la d\u00e9polarisation retard\u00e9e de la paroi ventriculaire impliqu\u00e9e ; il s\u2019agit d\u2019un crit\u00e8re majeur et fondamental de bloc de branche gauche ; la d\u00e9flexion intrins\u00e9co\u00efde est normale dans les pr\u00e9cordiales droites puisque le ventricule droit est activ\u00e9 normalement ;\r\n\r\n3. Un aspect QRS caract\u00e9ristique en V6 : on observe une positivit\u00e9 initiale, le sens de la d\u00e9polarisation septale \u00e9tant invers\u00e9 et le stimulus se propageant de droite \u00e0 gauche ; les forces d\u2019activation septale se dirigent donc vers les d\u00e9rivations pr\u00e9cordiales gauches qui enregistrent une d\u00e9flexion initiale positive ; la pr\u00e9sence d\u2019une onde q en V6 permet donc d\u2019\u00e9liminer le diagnostic de bloc de branche gauche ; l\u2019amplitude de l\u2019onde R est souvent augment\u00e9e ; en effet, lorsque l\u2019activation ventriculaire gauche est retard\u00e9e, elle ne rencontre plus d\u2019opposition de la part de la d\u00e9polarisation ventriculaire droite d\u2019o\u00f9 un potentiel plus volt\u00e9 ; le pied de l\u2019onde R est souvent emp\u00e2t\u00e9 ou parfois crochet\u00e9 puis la branche ascendante est relativement rapide et suivie d\u2019un fort ralentissement au sommet (bifidit\u00e9 ou aspect en plateau) et d\u2019une descente br\u00e8ve vers la ligne iso-\u00e9lectrique ; absence d\u2019onde s terminale ;\r\n\r\n4. Un aspect QRS caract\u00e9ristique en V1 : onde S large en rapport avec les forces gauches survenant avec retard ; l\u2019aspect le plus typique est donc rS ou QS ; \r\n\r\n5. Une modification du segment ST et de l\u2019onde T en V5, V6 : on retrouve fr\u00e9quemment un sous-d\u00e9calage du segment ST et une onde T invers\u00e9e avec possible sus- d\u00e9calage en V1 ;\r\n\r\n6. Dans les d\u00e9rivations frontales, on retrouve en DI et plus souvent encore en aVL, l\u2019aspect caract\u00e9ristique retrouv\u00e9 en V6 (positivit\u00e9 exclusive suivie d\u2019une onde T n\u00e9gative et sym\u00e9trique avec sous-d\u00e9calage) ;\r\n\r\nL\u2019axe du QRS est variable : il peut \u00eatre normal ou d\u00e9vi\u00e9 \u00e0 gauche.\r\n\r\nLa pr\u00e9sence d\u2019un bloc de branche gauche rend difficile le diagnostic d\u2019infarctus ou d\u2019hypertrophie ventriculaire.","ecg_info_post_answer":"\"\""},"yoast_head":"\nTrac\u00e9 3.2: Bloc de branche gauche et syncope - Cardiocases<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-2-bloc-de-branche-gauche-et-syncope\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 3.2: Bloc de branche gauche et syncope - 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