{"id":10093,"date":"2026-04-01T11:42:05","date_gmt":"2026-04-01T11:42:05","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10093"},"modified":"2026-04-08T15:10:09","modified_gmt":"2026-04-08T15:10:09","slug":"trace-3-3-bloc-de-branche-gauche-douloureux","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-3-bloc-de-branche-gauche-douloureux\/","title":{"rendered":"Trac\u00e9 3.3: Bloc de branche gauche douloureux"},"content":{"rendered":"","protected":false},"featured_media":10092,"template":"","ecg_case_type":[252],"language_ecgcase":[259],"class_list":["post-10093","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 3.3: Bloc de branche gauche douloureux","patient_description":"Jeune fille de 24 ans, sans ant\u00e9c\u00e9dent ni facteur de risque, pr\u00e9sentant des douleurs thora\u00ad ciques pour des efforts limit\u00e9s; r\u00e9alisation d\u2019un \u00e9lectrocardiogramme lors d\u2019un effort mo\u00ad d\u00e9r\u00e9","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) vrai(s) pour la deuxi\u00e8me partie de l\u2019ECG?","quiz_answer_1":"bloc de branche gauche","quiz_answer_2":"bloc de branche droit + h\u00e9mibloc ant\u00e9rieur gauche","quiz_answer_3":"bloc de branche droit","quiz_answer_4":"bloc indiff\u00e9renci\u00e9","quiz_answer_5":"h\u00e9mibloc ant\u00e9rieur gauche","correct_answer":["A"],"ecg_image":10640,"ecg_description":"Dans la premi\u00e8re partie du trac\u00e9, le rythme est sinusal avec un intervalle PR normal et un QRS fin; \u00e0 la faveur d\u2019une l\u00e9g\u00e8re augmentation de la fr\u00e9quence cardiaque, apparition d\u2019un 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":"L'apparition d\u2019un bloc de branche gauche \u00e0 l\u2019effort peut causer des douleurs thoraciques sans anomalie du r\u00e9seau coronaire.","commentary_ecg":"","ecg_info_post_answer":"\"\"\r\n\r\n \r\n\r\n \r\n\r\n\"\"\r\n\r\n \r\n\r\nDescription trac\u00e9<\/strong>\r\n\r\nTrac\u00e9 inverse; \u00e0 la faveur d\u2019un l\u00e9ger ralentissement, disparition de l\u2019aspect de bloc de branche gauche et retour des QRS fins;\r\n\r\nCommentaires<\/strong>\r\n\r\nCette jeune patiente pr\u00e9sentait des douleurs thoraciques typiques en l\u2019absence d\u2019ant\u00e9c\u00e9dent notable ou de facteurs de risque. Ces douleurs apparaissaient pour des efforts relativement modestes. L\u2019\u00e9lectrocardiogramme r\u00e9alis\u00e9 au repos montrait des complexes QRS fins de morphologie et de dur\u00e9e normales, une repolarisation sans anomalie. Un \u00e9lectrocardiogramme d\u2019effort a \u00e9t\u00e9 enregistr\u00e9 avec mise en \u00e9vidence pour une augmentation limit\u00e9e de la fr\u00e9quence cardiaque, d\u2019un aspect de bloc de branche gauche typique contemporain de la survenue de la douleur. A l\u2019arr\u00eat de l\u2019effort, la normalisation du trac\u00e9 s\u2019accompagnait de la disparition de la douleur. L\u2019\u00e9chographie cardiaque \u00e9tait normale. Une coronarographie mettait en \u00e9vidence des art\u00e8res coronaires saines sans possibilit\u00e9 de d\u00e9clencher un spasme.\r\n\r\nLe diagnostic final \u00e9tait donc celui de bloc de branche gauche douloureux d\u2019effort devant l\u2019association entre douleur thoracique concomitante de l\u2019apparition d\u2019un bloc gauche et disparaissant avec la normalisation de l\u2019ECG et art\u00e8res coronaires sans anomalie. Les m\u00e9canismes impliqu\u00e9s dans la gen\u00e8se de la douleur sont encore mal compris. Diff\u00e9rentes hypoth\u00e8ses ont \u00e9t\u00e9 propos\u00e9es: asynchronisme ventriculaire, isch\u00e9mie septale li\u00e9e \u00e0 une hypoperfusion septale ou une hyperperfusion lat\u00e9rale relative. Quelques cas cliniques ont sugg\u00e9r\u00e9 une cause m\u00e9dicamenteuse possible (apparition apr\u00e8s introduction d\u2019un traitement antipalud\u00e9en, d\u2019un traitement par fl\u00e9ca\u00efnide). L\u2019\u00e9volution est variable en fonction des patients. Le bloc de branche peut devenir permanent avec disparition des douleurs. En l\u2019absence de coronaropathie, il semble que le pronostic de ces patients reste conserv\u00e9."},"yoast_head":"\nTrac\u00e9 3.3: Bloc de branche gauche douloureux - 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-3-3-bloc-de-branche-gauche-douloureux\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 3.3: Bloc de branche gauche douloureux - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-3-bloc-de-branche-gauche-douloureux\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-08T15:10:09+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-3-3-ecg-2.jpeg\" \/>\n\t<meta property=\"og:image:width\" content=\"1754\" \/>\n\t<meta property=\"og:image:height\" content=\"1125\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-3-bloc-de-branche-gauche-douloureux\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-3-bloc-de-branche-gauche-douloureux\/\",\"name\":\"Trac\u00e9 3.3: Bloc de branche gauche douloureux - 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