{"id":10168,"date":"2026-04-02T19:49:59","date_gmt":"2026-04-02T19:49:59","guid":{"rendered":"https:\/\/cardiocases.com\/?post_type=ecg_case&#038;p=10168"},"modified":"2026-04-09T09:56:21","modified_gmt":"2026-04-09T09:56:21","slug":"trace-6-2-tachycardie-sinusale","status":"publish","type":"ecg_case","link":"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-2-tachycardie-sinusale\/","title":{"rendered":"Trac\u00e9 6.2: Tachycardie sinusale"},"content":{"rendered":"","protected":false},"featured_media":10167,"template":"","ecg_case_type":[255],"language_ecgcase":[259],"class_list":["post-10168","ecg_case","type-ecg_case","status-publish","has-post-thumbnail","hentry","ecg_case_type-atrial-fibrillation-atrial-flutter-atrial-tachycardia","language_ecgcase-french"],"acf":{"ecg_case_title":"Trac\u00e9 6.2: Tachycardie sinusale","patient_description":"Femme de 54 ans avec valvulopathie mitrale, insuffisance r\u00e9nale chronique, an\u00e9mie mo\u00ad d\u00e9r\u00e9e ; hospitalisation pour d\u00e9compensation cardiaque sur surinfection bronchique f\u00e9\u00ad brile","quiz_question":"Quelle(s) est(sont) l\u2019(les) anomalie(s) pr\u00e9sente(s) sur ce trac\u00e9?","quiz_answer_1":"tachycardie sinusale","quiz_answer_2":"fibrillation auriculaire","quiz_answer_3":"flutter atrial","quiz_answer_4":"r\u00e9entr\u00e9e intranodale","quiz_answer_5":"r\u00e9entr\u00e9e sur voie accessoire","correct_answer":["A"],"ecg_image":10167,"ecg_description":"Ce trac\u00e9 montre une tachycardie \u00e0 170 bpm d\u2019origine sinusale (rapport oreillettes\/ventricules en 1\/1, activit\u00e9 atriale pr\u00e9c\u00e9dant le QRS positive en DI, DII, V5, V6, n\u00e9gative en aVR); probable hypertrophie ventriculaire gauche avec augmentation du voltage de l\u2019onde S en V3 et de l\u2019onde R en V5;","ecg_info_box":"Dans une majorit\u00e9 de cas, la tachycardie sinusale ne doit pas \u00eatre consid\u00e9r\u00e9e comme un v\u00e9ritable trouble du rythme, mais comme une r\u00e9ponse physiologique adapt\u00e9e \u00e0 un besoin m\u00e9tabolique accru ou un processus pathologique g\u00e9n\u00e9ral.","commentary_ecg":"Cette patiente pr\u00e9sente une tachycardie sinusale qui se d\u00e9finit comme une fr\u00e9quence sinusale de repos sup\u00e9rieure \u00e0 100 bpm. Le diagnostic \u00e9lectrocardiographique de tachycardie sinusale est ais\u00e9 si la tachycardie n\u2019est pas trop rapide permettant une bonne diff\u00e9renciation entre ondes P, complexes QRS et ondes T. Les ondes P sinusales pr\u00e9c\u00e8dent et commandent la survenue des complexes QRS. Quand le rythme s\u2019acc\u00e9l\u00e8re au del\u00e0 d\u2019une certaine fr\u00e9quence, le raccourcissement des diastoles entraine une superposition des ondes P et des ondes T, la pr\u00e9sence d\u2019un crochetage de l\u2019onde T \u00e9tant le seul signe r\u00e9v\u00e9lateur de l\u2019activit\u00e9 atriale. Retrouver les caract\u00e9ristiques sugg\u00e9rant l\u2019origine sinusale de l\u2019activit\u00e9 atriale (positive en DI, DII, V5, V6 et n\u00e9gative en aVR) peut alors \u00eatre difficile. Le profil d\u2019\u00e9volution de la fr\u00e9quence cardiaque (si le patient est t\u00e9l\u00e9m\u00e9tr\u00e9) peut \u00eatre tr\u00e8s \u00e9vocateur de tachycardie sinusale, si l\u2019on peut mettre en \u00e9vidence une acc\u00e9l\u00e9ration et une d\u00e9c\u00e9l\u00e9ration progressives de la fr\u00e9quence. La fr\u00e9quence d\u00e9passe rarement 180 bpm chez l\u2019adulte. La tachycardie peut entrainer un sous-d\u00e9calage mod\u00e9r\u00e9 du segment ST et un aplatissement des ondes T.\r\n\r\nDans une majorit\u00e9 de cas, la tachycardie ne doit pas \u00eatre consid\u00e9r\u00e9e comme un v\u00e9ritable trouble du rythme, mais comme une r\u00e9ponse physiologique adapt\u00e9e \u00e0 un besoin m\u00e9tabolique accru ou un processus pathologique g\u00e9n\u00e9ral (fi\u00e8vre, an\u00e9mie, avitaminose B1, hypovol\u00e9mie, insuffisance cardiaque, cachexie, hyperthyro\u00efdie, embolie pulmonaire ...), un stress physiologique (\u00e9motion, anxi\u00e9t\u00e9, douleur ...) ou pharmacologique (sympathomim\u00e9tique ...). Chez cette patiente, diff\u00e9rents facteurs peuvent expliquer l\u2019existence d\u2019une tachycardie sinusale r\u00e9actionnelle (an\u00e9mie, insuffisance r\u00e9nale, d\u00e9compensation cardiaque, fi\u00e8vre, surinfection). Dans ce cadre, le traitement ne porte pas sur la tachycardie mais sur ses causes.\r\n\r\nDans de rares cas, la tachycardie sinusale n\u2019est pas consid\u00e9r\u00e9e comme adaptative et secondaire \u00e0 une demande m\u00e9tabolique accrue ou \u00e0 une hyperstimulation m\u00e9dicamenteuse et il faut alors \u00e9voquer le diagnostic de tachycardie sinusale inappropri\u00e9e. Les m\u00e9canismes impliqu\u00e9s sont encore mal d\u00e9finis. La symptomatologie est variable mais peut \u00eatre tr\u00e8s invalidante avec survenue r\u00e9p\u00e9t\u00e9e de palpitations, dyspn\u00e9e, limitation de la capacit\u00e9 d\u2019effort, lipothymie ou m\u00eame syncope. La fr\u00e9quence s\u2019acc\u00e9l\u00e8re rapidement pour des efforts modestes et redescend beaucoup plus lentement en r\u00e9cup\u00e9ration. Si l\u2019acc\u00e9l\u00e9ration de fr\u00e9quence est essentiellement posturale, il faut rechercher un syndrome de tachycardie orthostatique posturale qui constitue une entit\u00e9 diff\u00e9rente. La tachycardie sinusale inappropri\u00e9e concerne principalement des patients jeunes, plut\u00f4t de sexe f\u00e9minin parfois dans un contexte psychologique anxieux conduisant \u00e0 un nombre important de consultations. Le pronostic au long cours de ce type de dysautonomie est bon. Le traitement de facteurs favorisants (prise excessive de caf\u00e9ine, d\u00e9conditionnement \u00e0 l\u2019effort, anxi\u00e9t\u00e9) constitue la premi\u00e8re \u00e9tape de la prise en charge. Parfois, devant la persistance de sympt\u00f4mes survenant dans un contexte de tachycardie sinusale, l\u2019introduction d\u2019un traitement m\u00e9dical s\u2019av\u00e8re n\u00e9cessaire. Les b\u00eatabloquants et l\u2019ivabradine constituent les traitements de premi\u00e8re intention, leur tol\u00e9rance n\u2019\u00e9tant toutefois pas toujours parfaite. La modulation du n\u0153ud sinusal par radiofr\u00e9quence est tr\u00e8s exceptionnellement propos\u00e9e devant une tachycardie r\u00e9fractaire invalidante en raison d\u2019un taux de succ\u00e8s limit\u00e9 et d\u2019un risque de complications non n\u00e9gligeable. ","ecg_info_post_answer":"<img class=\"alignnone wp-image-10326 size-large\" src=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/04\/page-253-1024x600.png\" alt=\"\" width=\"800\" height=\"469\" \/>"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Trac\u00e9 6.2: Tachycardie sinusale - 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-6-2-tachycardie-sinusale\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Trac\u00e9 6.2: Tachycardie sinusale - Cardiocases\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cardiocases.com\/fr\/ecg_case\/trace-6-2-tachycardie-sinusale\/\" \/>\n<meta property=\"og:site_name\" content=\"Cardiocases\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-09T09:56:21+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-2-ecg-2-scaled.png\" \/>\n\t<meta property=\"og:image:width\" content=\"2560\" \/>\n\t<meta property=\"og:image:height\" content=\"1480\" \/>\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-6-2-tachycardie-sinusale\/\",\"url\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-2-tachycardie-sinusale\/\",\"name\":\"Trac\u00e9 6.2: Tachycardie sinusale - Cardiocases\",\"isPartOf\":{\"@id\":\"https:\/\/cardiocases.com\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-2-tachycardie-sinusale\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-2-tachycardie-sinusale\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-2-ecg-2-scaled.png\",\"datePublished\":\"2026-04-02T19:49:59+00:00\",\"dateModified\":\"2026-04-09T09:56:21+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-2-tachycardie-sinusale\/#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/cardiocases.com\/ecg_case\/trace-6-2-tachycardie-sinusale\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-2-tachycardie-sinusale\/#primaryimage\",\"url\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-2-ecg-2-scaled.png\",\"contentUrl\":\"https:\/\/cardiocases.com\/wp-content\/uploads\/2026\/03\/trace-6-2-ecg-2-scaled.png\",\"width\":2560,\"height\":1480},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/cardiocases.com\/ecg_case\/trace-6-2-tachycardie-sinusale\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/cardiocases.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Trac\u00e9 6.2: Tachycardie sinusale\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/cardiocases.com\/#website\",\"url\":\"https:\/\/cardiocases.com\/\",\"name\":\"Cardiocases\",\"description\":\"Real cardiac device traces, pacemaker &amp; 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