{"id":10109,"date":"2026-04-01T12:02:39","date_gmt":"2026-04-01T12:02:39","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10109"},"modified":"2026-04-09T09:41:47","modified_gmt":"2026-04-09T09:41:47","slug":"trace-3-10-hemibloc-anterieur-gauche","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/","title":{"rendered":"Trac\u00e9 3.10: H\u00e9mibloc ant\u00e9rieur gauche"},"content":{"rendered":"","protected":false},"featured_media":10108,"template":"","ecg_case_type":[252],"language_ecgcase":[259],"class_list":["post-10109","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 3.10: H\u00e9mibloc ant\u00e9rieur gauche","patient_description":"Homme de 24 ans, sans ant\u00e9c\u00e9dent","quiz_question":"Quel(s) est(sont) le(s) diagnostic(s) vrai(s) pour cet ECG?","quiz_answer_1":"hypertrophie auriculaire gauche","quiz_answer_2":"bloc de branche indiff\u00e9renci\u00e9","quiz_answer_3":"s\u00e9quelle de n\u00e9crose inf\u00e9rieure","quiz_answer_4":"hypertrophie ventriculaire gauche","quiz_answer_5":"h\u00e9mibloc ant\u00e9rieur gauche","correct_answer":["E"],"ecg_image":10108,"ecg_description":"Activit\u00e9 sinusale; PR normal, QRS fin; h\u00e9mibloc ant\u00e9rieur gauche: axe gauche, aspect rS dans les d\u00e9rivations inf\u00e9rieures, aspect qR en DI, aVL, onde R plus pr\u00e9coce en aVR qu\u2019en aVL, onde q en V1-V2;","ecg_info_box":"-","commentary_ecg":"Ce patient pr\u00e9sente un aspect \u00e9lectrocardiographique typique d\u2019h\u00e9mibloc ant\u00e9rieur gauche. L\u2019onde d\u2019activation \u00e9lectrique ventriculaire gauche se subdivise normalement en suivant un fascicule ant\u00e9rieur et un fascicule post\u00e9rieur m\u00eame si il est parfois difficile de diff\u00e9rencier les 2 faisceaux anatomiquement et qu\u2019il peut exister une troisi\u00e8me branche courte, m\u00e9diane et septale. Si l\u2019h\u00e9mibloc post\u00e9rieur gauche est tr\u00e8s rare, l\u2019h\u00e9mibloc ant\u00e9rieur gauche est le trouble de conduction le plus fr\u00e9quemment observ\u00e9. En effet, le faisceau ant\u00e9rieur, responsable de l\u2019activation des parties hautes du septum et des parties ant\u00e9rolat\u00e9rales du ventricule gauche, est tr\u00e8s fin et vuln\u00e9rable (par compression ou par \u00e9tirement au niveau de la chambre de chasse). A l\u2019oppos\u00e9, l\u2019h\u00e9mibranche post\u00e9rieure b\u00e9n\u00e9ficie d\u2019une double vascularisation et est expos\u00e9e \u00e0 des pressions plus faibles et \u00e0 moins de turbulences. Un h\u00e9mibloc ant\u00e9rieur gauche peut \u00eatre idiopathique chez un patient avec c\u0153ur sain ou observ\u00e9 dans le cadre d\u2019une cardiopathie (isch\u00e9mique, cong\u00e9nitale, valvulaire, hypertensive). \r\n\r\nLa conduction \u00e9lectrique \u00e9tant bloqu\u00e9e dans l\u2019h\u00e9mibranche ant\u00e9rieure gauche, la primo-activation ventriculaire gauche est assur\u00e9e par le r\u00e9seau de Purkinje de la paroi post\u00e9ro-inf\u00e9rieure (partie initiale du complexe QRS). L\u2019activation ventriculaire gauche gagne ensuite la partie ant\u00e9rieure par conduction musculaire (partie moyenne et finale du complexe QRS) et tourne donc dans le sens antihoraire. Ce type d\u2019activation ventriculaire gauche est associ\u00e9 \u00e0 des modifications caract\u00e9ristiques du vecteur initial et du vecteur principal: \r\n\u2022 Le vecteur initial prend une orientation anormale vers la droite, l\u2019avant et vers le bas; \r\n\u2022 Le vecteur principal prend une orientation anormale vers le haut, la gauche et l\u2019arri\u00e8re;\r\n\r\nL\u2019\u00e9lectrocardiogramme retrouve:\r\n\r\n1. Une dur\u00e9e du QRS soit normale soit l\u00e9g\u00e8rement augment\u00e9e (autour de 100 ms mais toujours inf\u00e9rieure \u00e0 120 ms); si la dur\u00e9e est plus large, une anomalie associ\u00e9e doit \u00eatre recherch\u00e9e;\r\n\r\n2. Un axe du QRS d\u00e9vi\u00e9 \u00e0 gauche (entre -40 et -90 degr\u00e9); l\u2019orientation anormale du vecteur principal vers la gauche, l\u2019arri\u00e8re et le haut explique cette d\u00e9viation axiale gauche;\r\n\r\n3. Un aspect qR dans les d\u00e9rivations DI et aVL; la petite onde q observ\u00e9e est en rapport avec la d\u00e9viation vers la droite, l\u2019avant et vers le bas des vecteurs initiaux; \r\n\r\n4. Un aspect rS dans les d\u00e9rivations inf\u00e9rieures (DII, DIII et aVF); l\u2019onde r initiale est expliqu\u00e9e par la d\u00e9viation vers la droite, l\u2019avant et vers le bas des vecteurs initiaux, l\u2019onde S profonde par la d\u00e9viation vers la gauche, l\u2019arri\u00e8re et le haut du vecteur principal;\r\n\r\n5. On observe parfois une augmentation des voltages dans les d\u00e9rivations frontales sans hypertrophie ventriculaire associ\u00e9e;\r\n\r\n6. Dans les d\u00e9rivations pr\u00e9cordiales droites, on peut observer un aspect normal de type rS ou un aspect qrS avec pr\u00e9sence d\u2019une onde q anormale due \u00e0 la modification de l\u2019orientation des vecteurs d\u2019activation septale; la pr\u00e9sence de ces ondes q et un certain rabotage des ondes R ne doivent pas faire poser \u00e0 tort le diagnostic de s\u00e9quelle d\u2019infarctus;\r\n\r\n7. Dans les d\u00e9rivations pr\u00e9cordiales gauches, l\u2019aspect peut \u00eatre normal (qR ou qRs); on peut observer une onde S relativement importante voire pr\u00e9dominante (aspects RS ou rS) avec aspect R\/S < 1; le d\u00e9placement de la zone de transition vers la gauche est en rapport avec l\u2019orientation sup\u00e9rieure des forces principales du QRS entrainant une r\u00e9duction d\u2019amplitude des ondes R dans les d\u00e9rivations pr\u00e9cordiales gauches;\r\n\r\n8. Le d\u00e9lai d\u2019inscription de la d\u00e9flexion intrins\u00e9co\u00efde est normal \u00e0 la fois dans les d\u00e9rivations pr\u00e9cordiales droites et pr\u00e9cordiales gauches;\r\n\r\n9. La direction et l\u2019aspect de la repolarisation sont en g\u00e9n\u00e9ral normaux (possibilit\u00e9 onde T n\u00e9gative en aVL);\r\n","ecg_info_post_answer":"<img class=\"alignnone wp-image-10313 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-139-1024x555.png\" alt=\"\" width=\"800\" height=\"434\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 3.10: 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-3-10-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 3.10: H\u00e9mibloc ant\u00e9rieur gauche - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-09T09:41:47+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-3-10-ecg-3-scaled-e1775044855596-1024x488.png\" \/>\n\t<meta property=\"og:image:width\" content=\"1024\" \/>\n\t<meta property=\"og:image:height\" content=\"488\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\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-3-10-hemibloc-anterieur-gauche\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/\",\"name\":\"Trac\u00e9 3.10: H\u00e9mibloc ant\u00e9rieur gauche - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-3-10-ecg-3-scaled-e1775044855596.png\",\"datePublished\":\"2026-04-01T12:02:39+00:00\",\"dateModified\":\"2026-04-09T09:41:47+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-3-10-ecg-3-scaled-e1775044855596.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-3-10-ecg-3-scaled-e1775044855596.png\",\"width\":2560,\"height\":1219},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 3.10: H\u00e9mibloc ant\u00e9rieur gauche\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; ICD learning \u2014 built by electrophysiologists\",\"publisher\":{\"@id\":\"https:\/\/cardiocases.com\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/cardiocases.com\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/cardiocases.com\/#organization\",\"name\":\"Cardiocases\",\"url\":\"https:\/\/cardiocases.com\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/07\/cardiocases_logo.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/07\/cardiocases_logo.png\",\"width\":1755,\"height\":499,\"caption\":\"Cardiocases\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/#\/schema\/logo\/image\/\"},\"sameAs\":[\"https:\/\/www.linkedin.com\/company\/cardiocases\/\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Trac\u00e9 3.10: H\u00e9mibloc ant\u00e9rieur gauche - Cardiocases","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/","og_locale":"fr_FR","og_type":"article","og_title":"Trac\u00e9 3.10: H\u00e9mibloc ant\u00e9rieur gauche - Cardiocases","og_url":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/","og_site_name":"Cardiocases","article_modified_time":"2026-04-09T09:41:47+00:00","og_image":[{"width":1024,"height":488,"url":"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-3-10-ecg-3-scaled-e1775044855596-1024x488.png","type":"image\/png"}],"twitter_card":"summary_large_image","twitter_misc":{"Dur\u00e9e de lecture estim\u00e9e":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/","url":"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/","name":"Trac\u00e9 3.10: H\u00e9mibloc ant\u00e9rieur gauche - Cardiocases","isPartOf":{"@id":"https:\/\/cardiocases.com\/#website"},"primaryImageOfPage":{"@id":"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/#primaryimage"},"image":{"@id":"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/#primaryimage"},"thumbnailUrl":"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-3-10-ecg-3-scaled-e1775044855596.png","datePublished":"2026-04-01T12:02:39+00:00","dateModified":"2026-04-09T09:41:47+00:00","breadcrumb":{"@id":"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/#breadcrumb"},"inLanguage":"fr-FR","potentialAction":[{"@type":"ReadAction","target":["https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/"]}]},{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/#primaryimage","url":"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-3-10-ecg-3-scaled-e1775044855596.png","contentUrl":"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-3-10-ecg-3-scaled-e1775044855596.png","width":2560,"height":1219},{"@type":"BreadcrumbList","@id":"https:\/\/cardiocases.com\/ecg_case\/trace-3-10-hemibloc-anterieur-gauche\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/cardiocases.com\/"},{"@type":"ListItem","position":2,"name":"Trac\u00e9 3.10: H\u00e9mibloc ant\u00e9rieur gauche"}]},{"@type":"WebSite","@id":"https:\/\/cardiocases.com\/#website","url":"https:\/\/cardiocases.com\/","name":"Cardiocases","description":"Real cardiac device traces, pacemaker &amp; ICD learning \u2014 built by electrophysiologists","publisher":{"@id":"https:\/\/cardiocases.com\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/cardiocases.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"fr-FR"},{"@type":"Organization","@id":"https:\/\/cardiocases.com\/#organization","name":"Cardiocases","url":"https:\/\/cardiocases.com\/","logo":{"@type":"ImageObject","inLanguage":"fr-FR","@id":"https:\/\/cardiocases.com\/#\/schema\/logo\/image\/","url":"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/07\/cardiocases_logo.png","contentUrl":"https:\/\/cardiocases.com\/wp-content\/uploads\/2025\/07\/cardiocases_logo.png","width":1755,"height":499,"caption":"Cardiocases"},"image":{"@id":"https:\/\/cardiocases.com\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.linkedin.com\/company\/cardiocases\/"]}]}},"_links":{"self":[{"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/ecg_case\/10109","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/ecg_case"}],"about":[{"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/types\/ecg_case"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/media\/10108"}],"wp:attachment":[{"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/media?parent=10109"}],"wp:term":[{"taxonomy":"ecg_case_type","embeddable":true,"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/ecg_case_type?post=10109"},{"taxonomy":"language_ecgcase","embeddable":true,"href":"https:\/\/cardiocases.com\/fr\/wp-json\/wp\/v2\/language_ecgcase?post=10109"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}