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La Fibrillation Auriculaire (French) Symposia - The CRUDEM Foundation

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La Fibrillation Auriculaire (French) Symposia presented in Milot, Haiti at Hôpital Sacré Coeur.

CRUDEM’s Education Committee (a subcommittee of the Board of Directors) sponsors one-week medical symposia on specific medical topics, i.e. diabetes, infectious disease. The classes are held at Hôpital Sacré Coeur and doctors and nurses come from all over Haiti to attend.

Published in: Health & Medicine
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La Fibrillation Auriculaire (French) Symposia - The CRUDEM Foundation

  1. 1. Anthony Karabanow, MD
  2. 2. ECG QRS étroit Réponse ventriculaire irrégulière irrégulière Manque dondes P (remplacées par les ondes f)
  3. 3. La terminologie la FA paroxystique récidivante:  se terminant spontanément en moins de 7 jours (généralement en moins de 24 heures) la FA persistante: > 7 jours la FA permanente: > un année
  4. 4. Présentation clinique Les palpitations La dyspnée La faiblesse Les étourdissements La capacité dexercice réduite Accident vasculaire cérébral
  5. 5. Présentation clinique Des études de surveillance ont montré quenviron 90 pour cent des patients ont des épisodes récurrents de FA 90 pour cent des épisodes ne sont pas reconnus par le patient
  6. 6. Physiopathologie Déclencheur:  Décharge rapide à partir dun lieu unique dans les veines pulmonaires  Autres décharges focales  Linstabilité autonomique
  7. 7. Physiopathologie Substrat:  Remodelage électrique des oreillettes  La fibrose  Linflammation  Dilitation
  8. 8. Les facteurs de risque• Âge• Hypertension• La maladie coronarienne*• Linsuffisance cardiaque chronique• La cardiopathie valvulaire• L’hyperthyroïdie• L’ alcool• Les maladies pulmonaires
  9. 9. La maladie coronarienne Pas une association commune Se produit dans 0,6% chez les patients ayant une maladie coronarienne stable (étude CASS 88) Une présentation peu fréquente dun infarctus du myocarde
  10. 10. La maladie coronarienne J Am Coll Cardiol. 2000;36(4):1223: “Élévation ou dépression > 2 mm du segment ST à lECG apparaît pour déterminer quels patients sont à risque dinfarctus du myocarde. Les patients sans dimportantes modifications du segment ST sont à très faible risque dIM.’’
  11. 11. La cardiopathie valvulaire Am J Cardiol. 1996;77(1):96: Il y a une prévalence élevée dans les cardiopathies rhumatismales:  sténose mitrale et régurgitation mitrale et régurgitation tricuspidienne 70%  sténose mitrale et régurgitation mitrale 52%  sténose mitrale 29%  régurgitation mitrale 16%
  12. 12. Alcool Fibrillation auriculaire survient chez jusquà 60% de buveurs de binge Augmentation du risque parmi les buveurs excessifs
  13. 13. Évaluation Est-ce la fibrillation auriculaire représente une urgence? Échocardiogramme Radiographie thoracique TSH Les enzymes cardiaques sont inutiles
  14. 14. Cas durgence Critères:  lischémie actif  ICC sévère  hypotension sévère
  15. 15. Cas durgence Nécessite une cardioversion durgence:  120 à 200 joules pour les appareils biphasique et 200 joules pour les appareils monophasiques
  16. 16. Le traitement Contrôler le rythme Contrôler la fréquence Prévenir les AVC
  17. 17. Contrôler le rythme Il nya aucun avantage de la mortalité pour contrôler le rythme plus de contrôle de la fréquence Les anti-arythmiques doivent PAS être systématiquement utilisés
  18. 18. Contrôler le rythme Peut être nécessaire chez les patients avec des symptômes persistants malgré un contrôle de la fréquence On a besoin de coumadin pendant 1 mois avant et après la cardioversion:  Les médicaments (la flécaïnide est le plus efficace)  La cardioversion électrique
  19. 19. Contrôle de la fréquence La digoxine nest pas un bon choix:  Vagotonique  Facilement surmontées par le ton adrénergique accrue Les médicaments préférés:  Les bêtabloquants (aténolol, métoprolol)  Les inhibiteurs calciques (vérapamil, diltiazem)
  20. 20. La prévention des AVC Tous les patients souffrant de fibrillation auriculaire sont à risque dAVC embolique (3-5% par an) Les patients atteints de la fibrillation auriculaire sont à risque dAVC plus sévère que ceux atteints de la maladie carotidienne La prévention des AVC doit être abordé chez tous les patients souffrant de la fibrillation auriculaire
  21. 21. La prévention des AVC CHADS2 = 0 laspirine CHADS2 = 1 laspirine ou le coumadin CHADS2 > = 2 le coumadin
  22. 22. Lexamen Lequel de ces bandes rythme suivant représente la fibrillation auriculaire?
  23. 23. L’examen Lévaluation initiale dun patient souffrant de fibrillation auriculaire comprend:
  24. 24. L’examen Les trois éléments dun traitement fibrillation auriculaire comprennent:
  25. 25. L’examen Quel est le traitement approprié dun patient présentant une hypotension grave et la fibrillation auriculaire?
  26. 26. L’examen Comment calculez-vous le score CHADS2?
  27. 27. L’examen Quel est le traitement approprié pour éviter ACV chez un patient avec:  CHADS2 = 0  CHADS2 = 1  CHADS2 >= 2

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