on 13-Feb-2025 (Thu)

50 bpm

"Regular bradycardia is a heart rate of less than 50 beats/minute." - McGee

• Bradycardie sinusale
• Bloc atrio-ventriculaire complet
• "Pouls divisé" ("halved pulse")

"There are three causes of regular bradycardia that are recognizable at the bedside: sinus bradycardia, complete heart block, and halved pulse" - McGee

• Auscultation cardiaque du B1
• Palpation du choc de pointe
• Observation du pouls veineux jugulaire

• Changement d'intensité du B1
• Ondes A intermittentes en coup de canon

"Atrioventricular dissociation causes two important bedside findings: changing intensity of the first heart sound and intermittent cannon A waves in the venous pulse." - McGee

Rythme cardiaque REGULIER

"The finding of a changing first heart sound is only significant when the pulse is regular, because in irregular rhythms its intensity naturally varies with the length of the previous diastole (i.e., long diastoles intensify the first heart sound of the next beat; short diastoles diminish it)." - McGee

Dissociation atrio-ventriculaire

"If the ventricular pulse is regular, however, a changing intensity of the first heart sound (or intermittent “booming” of the first heart sound) indicates only one diagnosis, atrioventricular dissociation." - McGee

COURTE

Oreillettes se contracent juste avant les ventricules

"In complete heart block, the first heart sound of most beats is faint. Intermittently, however, the atrium contracts just before the ventricle contraction, which results in a first heart sound of booming intensity (named bruit de canon because of its explosive quality)." - McGee

20 à 50 % des cas

"The Valsalva maneuver is preferred for two reasons: (1) It tends to be more efficacious, terminating supraventricular tachycardia 20% to 50% of the time, [...]" - McGee

Valsalva

• Plus efficace
• Moins risquée (AVC et massages carotidiens chez sujets âgés)

"The Valsalva maneuver is preferred for two reasons: (1) It tends to be more efficacious, terminating supraventricular tachycardia 20% to 50% of the time, compared with only a 10% efficacy using carotid massage [...]" - McGee

Ralentissement temporaire

"Transient slowing of the pulse during a vagal maneuver indicates sinus tachycardia." - McGee

Terminaison brutale

"Abrupt termination of the tachycardia indicates paroxysmal supraventricular tachycardia (which occurs with both nodal reentry tachycardias and reciprocating tachycardias from accessory pathways)" - McGee

Brutale division par deux de la fréquence cardiaque

"Abrupt halving of the rate may occur in atrial flutter" - McGee

RIEN

"No response is unhelpful, being characteristic of ventricular tachycardia but also occurring with every other regular tachycardia." - McGee

5 secondes

"In carotid artery massage, the clinician finds the bifurcation of one carotid artery, located just below the angle of the jaw, and massages or presses on it for 5 seconds." - McGee

APRÈS la poussée, pendant le repos

"The Valsalva maneuver increases vagal tone and has its maximal effect on tachycardias after the release of the Valsalva, not while the patient is straining." - McGee

15 secondes

"Valsalva maneuver [...] In patients with supraventricular tachycardia, 15 seconds of straining is as effective as 30 seconds." - McGee

Décubitus dorsal

"Both maneuvers are performed when the patient is supine." - McGee

• Réponse aux manoeuvres vagales
• Signes de dissociation atrio-ventriculaire
• Anomalies du pouls veineux jugulaire

"The bedside observations that distinguish these arrhythmias are response to vagal maneuvers, signs of atrioventricular dissociation, and abnormalities of the neck veins" - McGee

• Tachycardie sinusale
• Flutter atrial
• Tachycardie supraventriculaire paroxystique
• Tachycardie ventriculaire

"The regular tachycardias that sometimes are recognizable at the bedside include sinus tachycardia, atrial flutter, paroxysmal supraventricular tachycardia, and ventricular tachycardia." - McGee

Dissociation auriculo-ventriculaire

"Other uncommon signs of atrioventricular dissociation are regular small A waves in the venous pulse" - McGee

Dissociation auriculo-ventriculaire

"Other uncommon signs of atrioventricular dissociation are [...] regular muffled fourth heart sounds at the apex; or in patients with mitral stenosis, regular short murmurs from the atrium pushing blood across the stenotic valve. All of these findings represent regular atrial contractions that continue during the long ventricular diastoles." - McGee