Bouveret Syndrome

Maladie de Bouveret

Bouveret SyndromeCLINICAL SIGNS:

* in a young subject, without a cardiovascular history.

* tachycardia attacks at the beginning and end abrupt (sensation of clicks) from a few minutes to several hours.

* the patient feels palpitations, precordialgia and anxiety.

* sometimes lipothymies, functional angina, syncope.

* regular rhythm , frequency to 180-220 / min .


* scope.

* ECG during the crisis if it is possible:

– Fine QRS , frequency at 180-200 / min, P waves are often invisible.

If the P wave is visible, it is negative at D2, D3, VF.

– more difficult diagnosis if functional block and QRS expanded.

* redo an ECG after the crisis to eliminate a WPW .

* TSH.


* vagal maneuvers :

– swallowing a glass of ice water.

– Valsalva maneuver: forced expiration carried out closed nose and mouth.

– immersion of the face in very cold water.

– painful ocular compression, except if retinal fragility and ocular hypertension especially in the elderly.

– massage of a single carotid sinus, right then left, for 20 seconds, except for a history of stroke or carotid breath.

* in case of failure:

– venous route: G5%, oxygen therapy in the mask.

– Striadyne :

 ½ to 1 direct IV ampoule (0.5-1 mg / kg IV in children).

 if cardiac pause: cough, if failure: Atropine, 1 mg IV and sternal punch.

 if contraindicated (asthma and COPD in particular):

 Tildiem 25: 0.25 to 0.30 mg / kg IV slow, Digoxin Nativelle: 1 slow IV ampoule (except if WPW), Cordarone: 5 mg / kg in 30 minutes or Isoptine: 5 mg in 5 minutes.

* rebellious forms:

– external electric shock under general anesthesia.

Destruction of the arrhythmogenic zone using radio frequency currents.