Prise en charge de la dyspnée aiguë suspecte d’insuffisance cardiaque en urgence : un challenge diagnostique et thérapeutique

Annales Françaises de Médecine d'Urgence. 2017 T. Chouihed · A. Bassand · N. Peschanski · G. Brembilla · A. Avondo · E. Bonnefoy-Cudraz · F. Coquet · N. Girerd · P. Ray

Diffusion le 03/03/2017


Résumé

Introduction : La dyspnée aiguë est un symptôme fréquent incluant l’insuffisance cardiaque aiguë (ICA). La prise en charge précoce des syndromes coronariens aigus a permis d’en améliorer le pronostic. La dyspnée est devenue un nouveau challenge diagnostique et thérapeutique. Cette mise au point présente la prise en charge de la dyspnée aiguë suspecte d’ICA.
En préhospitalier : Un traitement inapproprié ou un mauvais diagnostic sont responsables d’une surmortalité. Les  recommandations insistent sur la relation entre un diagnostic précoce, un traitement approprié et le pronostic, avec le concept récent de time-to-therapy. Différents outils sont disponibles dont l’échographie clinique, composée d’une échographie pulmonaire, d’une coupe 4 cavités, et d’une échographie vasculaire.
Dans le service d’accueil des urgences : La radiographie pulmonaire et les dosages biologiques sont recommandés.
Le peptide natriurétique de type B (brain natriuretic peptide [BNP]) permet d’améliorer la performance diagnostique,
mais sa valeur varie avec de nombreux facteurs. Il peut être normal en cas d’œdème aigu du poumon flash.
Traitement et orientation : Le concept de time-to-therapy a un rôle important dans la prise en charge de l’ICA. L’oxygène, la ventilation non invasive, les vasodilatateurs et les diurétiques sont recommandés le plus tôt possible. Toute première poussée d’ICA doit être hospitalisée, et tout patientprésentant une défaillance organique doit être admis en réanimation.
Conclusion : L’échographie pulmonaire associée au BNP sont des outils efficaces face à un patient dyspnéique. La thérapeutique doit être initiée le plus rapidement possible. L’amélioration du pronostic des patients insuffisants cardiaques repose sur une filière de prise en charge dès le préhospitalier.





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/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/Namespace.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Session/SaveHandler/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Uri.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/Version.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Doctype.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadMeta.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/HeadTitle.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Layout.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Abstract.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Container/Standalone.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Placeholder/Registry.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Helper/Url.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/Zend/View/Interface.php

ZFDebug Files

/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Cache.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Database.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Exception.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/File.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Interface.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Log/Writer.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Text.php
/var/www/vhosts/urgencesdirectinfo.com/sub/v3/httpdocs/library/ZFDebug/Controller/Plugin/Debug/Plugin/Variables.php