{"id":10103,"date":"2026-04-01T11:55:18","date_gmt":"2026-04-01T11:55:18","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&p=10103"},"modified":"2026-04-09T07:50:44","modified_gmt":"2026-04-09T07:50:44","slug":"trace-3-8-syncopes-chez-un-patient-avec-bloc-de-branche-droit-et-hemibloc-anterieur-gauche","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-8-syncopes-chez-un-patient-avec-bloc-de-branche-droit-et-hemibloc-anterieur-gauche\/","title":{"rendered":"Trac\u00e9 3.8: Syncopes chez un patient avec bloc de branche droit et h\u00e9mibloc ant\u00e9rieur gauche"},"content":{"rendered":"","protected":false},"featured_media":10102,"template":"","ecg_case_type":[252],"language_ecgcase":[259],"class_list":["post-10103","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 3.8: Syncopes chez un patient avec bloc de branche droit et h\u00e9mibloc ant\u00e9rieur gauche","patient_description":"Homme de 83 ans, insuffisance mitrale grade III en attente de chirurgie; 3 syncopes en 2 jours \u00e0 son domicile avec traumatisme facial et fracture de l\u2019os malaire","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":"bloc de branche indiff\u00e9renci\u00e9","correct_answer":["A","B","C"],"ecg_image":10102,"ecg_description":"A l\u2019arriv\u00e9e aux urgences, espace PR normal (180 ms), aspect de bloc de branche droit complet (dur\u00e9e QRS 120 ms, aspect rSR\u2019 en V1) avec h\u00e9miblocant\u00e9rieur gauche (axe gauche, onde q en D1 et onde S large en DII);","ecg_info_box":"Une d\u00e9viation axiale gauche chez un patient avec bloc de branche droit est en faveur de l\u2019existence d\u2019un h\u00e9mibloc ant\u00e9rieur gauche associ\u00e9.","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\nLe patient est hospitalis\u00e9 avec surveillance t\u00e9l\u00e9m\u00e9trique; nouvelle syncope avec mise en \u00e9vidence sur le trac\u00e9 d\u2019une asystolie prolong\u00e9e avec de nombreuses ondes P bloqu\u00e9es; rares \u00e9chappements ventriculaires;\r\n\r\n \r\n\r\nCommentaires<\/strong>\r\n\r\nCe patient pr\u00e9sente un bloc bifasciculaire. La d\u00e9viation axiale gauche se rajoutant \u00e0 un aspect typique de bloc de branche droit doit faire \u00e9voquer le diagnostic associ\u00e9 d\u2019h\u00e9mibloc ant\u00e9rieur gauche.\r\n\r\nCe patient se rend aux urgences \u00e0 la suite de la survenue de plusieurs syncopes sur une dur\u00e9e limit\u00e9e (2 jours). L\u2019\u00e9valuation clinique (plusieurs syncopes \u00e0 l\u2019emporte pi\u00e8ce sans facteur d\u00e9clenchant \u00e9vident) et \u00e9lectrocardiographique (trouble de conduction) est fortement en faveur d\u2019une origine cardiaque ce qui justifie d\u2019une hospitalisation imm\u00e9diate pour surveillance scopique ou t\u00e9l\u00e9m\u00e9trique. Les crit\u00e8res d\u2019hospitalisation en urgence \u00e0 la suite d\u2019une syncope incluent 1) l\u2019existence d\u2019une cardiopathie sousjacente 2) la pr\u00e9sence d\u2019une anomalie \u00e9lectrocardiographique en faveur d\u2019un trouble de conduction ou d\u2019un trouble du rythme 3) la syncope d\u2019effort 4) l\u2019existence d\u2019un traumatisme grave 5) histoire familiale de mort subite ou de maladie g\u00e9n\u00e9tique type Brugada.\r\n\r\nL\u2019association bloc de branche droite et h\u00e9mibloc ant\u00e9rieur gauche est relativement fr\u00e9quente. L\u2019h\u00e9mibloc d\u00e9vie les tous premiers vecteurs du QRS vers le bas et la droite, les vecteurs moyens vers le haut et la gauche. Le bloc de branche droit ajoute des vecteurs terminaux dirig\u00e9s vers la droite (potentiels du ventricule droit).\r\n\r\n \r\n\r\n\"\"\r\n\r\nDescription trac\u00e9<\/strong>\r\n\r\nUn stimulateur double chambre est implant\u00e9; l\u2019\u00e9lectrocardiogramme montre un rythme majoritairement d\u00e9tect\u00e9 dans l\u2019oreillette (un seul cycle auriculaire stimul\u00e9) et stimul\u00e9 dans le ventricule (sonde septale basse ventriculaire droite expliquant la n\u00e9gativit\u00e9 du QRS en DI et dans les d\u00e9rivations inf\u00e9rieures); mode de stimulation DDD (synchronisation des ventricules sur les oreillettes stimul\u00e9es ou d\u00e9tect\u00e9es);"},"yoast_head":"\nTrac\u00e9 3.8: Syncopes chez un patient avec bloc de branche droit et h\u00e9mibloc ant\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-3-8-syncopes-chez-un-patient-avec-bloc-de-branche-droit-et-hemibloc-anterieur-gauche\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 3.8: Syncopes chez un patient avec bloc de branche droit et h\u00e9mibloc ant\u00e9rieur gauche - 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