{"id":10101,"date":"2026-04-01T11:50:39","date_gmt":"2026-04-01T11:50:39","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10101"},"modified":"2026-04-01T11:50:40","modified_gmt":"2026-04-01T11:50:40","slug":"trace-3-7-syncopes-chez-un-patient-avec-bloc-de-branche-droit-et-hemibloc-posterieur-gauche","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-7-syncopes-chez-un-patient-avec-bloc-de-branche-droit-et-hemibloc-posterieur-gauche\/","title":{"rendered":"Trac\u00e9 3.7: Syncopes chez un patient avec bloc de branche droit et h\u00e9mibloc post\u00e9rieur gauche"},"content":{"rendered":"","protected":false},"featured_media":10100,"template":"","ecg_case_type":[252],"language_ecgcase":[259],"class_list":["post-10101","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 3.7: Syncopes chez un patient avec bloc de branche droit et h\u00e9mibloc post\u00e9rieur gauche","patient_description":"Homme de 78 ans, sans ant\u00e9c\u00e9dent connu, hospitalis\u00e9 pour syncope traumatisante","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) vrai(s) pour cet ECG?","quiz_answer_1":"rythme sinusal","quiz_answer_2":"h\u00e9mibloc ant\u00e9rieur gauche","quiz_answer_3":"bloc de branche droit","quiz_answer_4":"bloc de branche gauche","quiz_answer_5":"h\u00e9mibloc post\u00e9rieur gauche","correct_answer":["A","C","E"],"ecg_image":10100,"ecg_description":"Aspect de bloc de branche droit complet (dur\u00e9e de QRS > 120 ms, aspect rR\u2019 ou RsR\u2019 en V1-V2, retard de la d\u00e9flexion intrins\u00e9co\u00efde en V1, onde S large en V5-V6, troubles de la repolarisation en V1-V3) associ\u00e9 \u00e0 un h\u00e9mibloc post\u00e9rieur gauche (axe droit marqu\u00e9, aspect rS en DI et qR en DII, DIII)","ecg_info_box":"Une d\u00e9viation axiale droite majeure chez un patient avec bloc de branche droit peut traduire l\u2019existence d\u2019une hypertrophie ventriculaire droite ou d\u2019un h\u00e9mibloc post\u00e9rieur gauche associ\u00e9. L\u2019existence d\u2019un aspect qR en DII, DIII est plut\u00f4t en faveur d\u2019un h\u00e9mibloc post\u00e9rieur gauche associ\u00e9. ","commentary_ecg":"Ce patient pr\u00e9sente un bloc bifasciculaire avec association entre bloc de branche droit complet et h\u00e9mibloc post\u00e9rieur gauche. Cette forme est beaucoup moins fr\u00e9quente que l\u2019association bloc de branche droit h\u00e9mibloc ant\u00e9rieur gauche et certainement beaucoup plus pr\u00e9occupante. En effet, le risque d\u2019\u00e9volution vers un bloc auriculo-ventriculaire complet est augment\u00e9, l\u2019h\u00e9mibranche ant\u00e9rieure gauche qui assure seule la conduction \u00e9tant la moins dense et la plus vuln\u00e9rable. Il s\u2019agit donc d\u2019une indication de pose de stimulateur cardiaque surtout quand le patient est symptomatique et que les autres causes plausibles de syncope ont pu \u00eatre \u00e9limin\u00e9es. \r\n\r\nIl est difficile de diff\u00e9rencier bloc droit + h\u00e9mibloc post\u00e9rieur gauche et bloc droit + hypertrophie ventriculaire droite, une d\u00e9viation axiale droite \u00e9tant observ\u00e9e dans les 2 cas. L\u2019absence d\u2019argument clinique ou \u00e9chographique en faveur d\u2019une hypertrophie ventriculaire droite sugg\u00e8re ici le diagnostic de bloc bi-fasciculaire.","ecg_info_post_answer":"\"\""},"yoast_head":"\nTrac\u00e9 3.7: Syncopes chez un patient avec bloc de branche droit et h\u00e9mibloc post\u00e9rieur gauche - 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-3-7-syncopes-chez-un-patient-avec-bloc-de-branche-droit-et-hemibloc-posterieur-gauche\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 3.7: Syncopes chez un patient avec bloc de branche droit et h\u00e9mibloc post\u00e9rieur gauche - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-7-syncopes-chez-un-patient-avec-bloc-de-branche-droit-et-hemibloc-posterieur-gauche\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-01T11:50:40+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-7-syncopes-chez-un-patient-avec-bloc-de-branche-droit-et-hemibloc-posterieur-gauche\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-7-syncopes-chez-un-patient-avec-bloc-de-branche-droit-et-hemibloc-posterieur-gauche\/\",\"name\":\"Trac\u00e9 3.7: Syncopes chez un patient avec bloc de branche droit et h\u00e9mibloc post\u00e9rieur gauche - 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