{"id":7704,"date":"2026-02-20T18:15:42","date_gmt":"2026-02-20T17:15:42","guid":{"rendered":"https:\/\/reseau-amylose.org\/jesuissoignant\/?page_id=7704"},"modified":"2026-04-13T09:19:23","modified_gmt":"2026-04-13T07:19:23","slug":"dysautonomie-vasculaire-hypotension-orthostatique-amylose-cardiaque-soignants","status":"publish","type":"page","link":"https:\/\/reseau-amylose.org\/jesuissoignant\/dysautonomie-vasculaire-hypotension-orthostatique-amylose-cardiaque-soignants\/","title":{"rendered":"Dysautonomie Vasculaire et Hypotension Orthostatique dans l&rsquo;Amylose cardiaque"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"7704\" class=\"elementor elementor-7704\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2f2bd49 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2f2bd49\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1e1742a\" data-id=\"1e1742a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a43ee91 elementor-widget elementor-widget-heading\" data-id=\"a43ee91\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Dysautonomie Vasculaire et Hypotension Orthostatique dans l'Amylose\nCardiaque<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ba516c7 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"ba516c7\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-64da515 elementor-widget elementor-widget-heading\" data-id=\"64da515\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Comprendre, diagnostiquer et prendre en charge<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2686023 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2686023\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-00dd10f\" data-id=\"00dd10f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-22674f6 elementor-widget elementor-widget-text-editor\" data-id=\"22674f6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>L&rsquo;hypotension orthostatique (HO) d&rsquo;origine neurog\u00e8ne est une complication fr\u00e9quente et grave des amyloses cardiaques, particuli\u00e8rement dans les formes AL et ATTRv. Elle peut constituer le sympt\u00f4me inaugural dans environ 10 % des cas, exposant les patients \u00e0 une errance diagnostique prolong\u00e9e.<\/p><p>Sur le plan fonctionnel, l&rsquo;HO repr\u00e9sente une urgence \u00e0 ne pas sous-estimer : elle compromet la verticalisation, aggrave le risque de chutes et de traumatismes, et impacte significativement le pronostic vital \u2014 notamment par le risque de mort subite par d\u00e9samor\u00e7age de la pompe cardiaque.<\/p><p>\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b7c5a12 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b7c5a12\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0396900\" data-id=\"0396900\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9c9a3fa elementor-widget elementor-widget-heading\" data-id=\"9c9a3fa\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\u00c9pid\u00e9miologie : quels types d'amylose sont concern\u00e9s ?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ecaf9c0 elementor-widget elementor-widget-image\" data-id=\"ecaf9c0\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"768\" height=\"512\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/types-damylose-hypotension-orthostatique-768x512.png\" class=\"attachment-medium_large size-medium_large wp-image-7727\" alt=\"types-damylose-hypotension-orthostatique\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/types-damylose-hypotension-orthostatique-768x512.png 768w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/types-damylose-hypotension-orthostatique-300x200.png 300w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/types-damylose-hypotension-orthostatique-1024x683.png 1024w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/types-damylose-hypotension-orthostatique.png 1536w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7f70987 elementor-widget elementor-widget-text-editor\" data-id=\"7f70987\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Chez les patients AL pr\u00e9sentant un syndrome n\u00e9phrotique associ\u00e9 \u00e0 une atteinte cardiaque, 16 % pr\u00e9sentent une dysautonomie, avec un impact pronostique majeur (Sakhi et al., Amyloid 2025).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d230c24 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d230c24\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7838bba\" data-id=\"7838bba\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7b11cf3 elementor-widget elementor-widget-heading\" data-id=\"7b11cf3\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Physiopathologie de l'hypotension orthostatique neurog\u00e8ne<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-916308d elementor-widget elementor-widget-heading\" data-id=\"916308d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">M\u00e9canisme principal<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f833da2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f833da2\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-7bd2a72\" data-id=\"7bd2a72\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3f20a86 elementor-widget elementor-widget-heading\" data-id=\"3f20a86\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">En situation normale :<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b3e7d32 elementor-widget elementor-widget-image\" data-id=\"b3e7d32\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"285\" height=\"300\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/situation-normale-285x300.jpg\" class=\"attachment-medium size-medium wp-image-7712\" alt=\"hypotension-othostatique-amylose-cardiaque-situation-normale\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/situation-normale-285x300.jpg 285w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/situation-normale.jpg 662w\" sizes=\"(max-width: 285px) 100vw, 285px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-07fbf6c\" data-id=\"07fbf6c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-edbaeff elementor-widget elementor-widget-heading\" data-id=\"edbaeff\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Dans l'amylose :<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5938f49 elementor-widget elementor-widget-image\" data-id=\"5938f49\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"282\" height=\"300\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/dans-lamylose-282x300.jpg\" class=\"attachment-medium size-medium wp-image-7711\" alt=\"hypotension-othostatique-amylose-cardiaque\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/dans-lamylose-282x300.jpg 282w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/dans-lamylose.jpg 644w\" sizes=\"(max-width: 282px) 100vw, 282px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-bba37e6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"bba37e6\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e1e7586\" data-id=\"e1e7586\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cbe1abc elementor-widget elementor-widget-text-editor\" data-id=\"cbe1abc\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>En situation normale, le passage en orthostatisme d\u00e9clenche une r\u00e9ponse sympathique r\u00e9flexe avec augmentation de la nor\u00e9pin\u00e9phrine plasmatique, vasoconstriction p\u00e9riph\u00e9rique et tachycardie compensatrice. Dans l&rsquo;amylose, l&rsquo;infiltration amylo\u00efde des nerfs autonomes abolit cette r\u00e9ponse : la nor\u00e9pin\u00e9phrine plasmatique reste basse et ne s&rsquo;\u00e9l\u00e8ve pas \u00e0 l&rsquo;orthostatisme.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a7c1cec elementor-widget elementor-widget-text-editor\" data-id=\"a7c1cec\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Caract\u00e9ristique biologique<\/b> : La nor\u00e9pin\u00e9phrine plasmatique est basse et ne s&rsquo;\u00e9l\u00e8ve pas \u00e0 l&rsquo;orthostatisme.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-97a8939 elementor-widget elementor-widget-heading\" data-id=\"97a8939\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Le ph\u00e9notype labile \u2014 alternance HTA\/HO<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6e583eb elementor-widget elementor-widget-text-editor\" data-id=\"6e583eb\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>La dysautonomie vasculaire de l&rsquo;amylose g\u00e9n\u00e8re un ph\u00e9notype clinique caract\u00e9ristique :<\/p><ul><li><strong>En d\u00e9cubitus nocturne<\/strong>\u00a0: hypertension neurog\u00e8ne de d\u00e9cubitus (nSH \u2014 neurogenic Supine Hypertension), responsable d&rsquo;une natriur\u00e8se nocturne excessive<\/li><li><strong>Au lever<\/strong>\u00a0: hypovol\u00e9mie relative aggrav\u00e9e, hypotension profonde, incapacit\u00e9 \u00e0 vasoconstricter, r\u00e9ponse chronotrope inadapt\u00e9e<\/li><\/ul><p>La pression art\u00e9rielle est tr\u00e8s d\u00e9pendante de l&rsquo;\u00e9tat d&rsquo;hydratation, des repas, des \u00e9pisodes diarrh\u00e9iques, de la temp\u00e9rature ambiante, de l&rsquo;effort et de la douleur.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e62d7c2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e62d7c2\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3ca3525\" data-id=\"3ca3525\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a0f31c5 elementor-widget elementor-widget-heading\" data-id=\"a0f31c5\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Diagnostic de l'hypotension orthostatique dans l'amylose\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-47c6864 elementor-widget elementor-widget-heading\" data-id=\"47c6864\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">D\u00e9finition et crit\u00e8res diagnostiques<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-af30e40 elementor-widget elementor-widget-text-editor\" data-id=\"af30e40\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>L&rsquo;HO est d\u00e9finie par une chute, apr\u00e8s 3 minutes de station debout, d&rsquo;au moins :<\/p><ul><li><strong>20 mmHg<\/strong>\u00a0de la pression art\u00e9rielle systolique (PAS),\u00a0<strong>ou<\/strong><\/li><li><strong>10 mmHg<\/strong>\u00a0de la pression art\u00e9rielle diastolique (PAD)<\/li><\/ul><p><img loading=\"lazy\" decoding=\"async\" class=\"an1\" src=\"https:\/\/fonts.gstatic.com\/s\/e\/notoemoji\/17.0\/26a0_fe0f\/72.png\" alt=\"\u26a0\ufe0f\" width=\"30\" height=\"30\" data-emoji=\"\u26a0\ufe0f\" aria-label=\"\u26a0\ufe0f\" \/>\u00a0Les sympt\u00f4mes sont tr\u00e8s variables et parfois absents malgr\u00e9 une HO profonde. Un protocole de mesure standardis\u00e9 est indispensable.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-516b0e1 elementor-widget elementor-widget-heading\" data-id=\"516b0e1\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Protocole de mesure standardis\u00e9<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-235d0f0 elementor-widget elementor-widget-text-editor\" data-id=\"235d0f0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>\u00c9tapes obligatoires<\/b> :<\/p><ol><li>Repos 3 \u00e0 5 minutes en d\u00e9cubitus ou assis<\/li><li>Mesure TA\/FC en d\u00e9cubitus<\/li><li>Mesure TA\/FC debout \u00e0 1 minute<\/li><li>Mesure TA\/FC debout \u00e0 3 minutes<\/li><li>Notation syst\u00e9matique des sympt\u00f4mes : vertiges, flou visuel, voile noir, faiblesse, naus\u00e9es, douleur scapulaire<\/li><\/ol><p><em>Si la station debout est impossible : mesure en position assise (moins sensible).<\/em><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3215d11 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"3215d11\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-41d56ba\" data-id=\"41d56ba\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-28ab302 elementor-widget elementor-widget-heading\" data-id=\"28ab302\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Confirmer l'origine neurog\u00e8ne \u2014 Ratio \u0394FC\/\u0394PAS<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2f946e5 elementor-widget elementor-widget-text-editor\" data-id=\"2f946e5\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Formule :<\/strong>\u00a0Ratio = (FC debout \u2013 FC couch\u00e9) \/ (PAS couch\u00e9 \u2013 PAS debout)<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-37a4d93 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"37a4d93\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6d6fade\" data-id=\"6d6fade\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-30269d3 elementor-widget elementor-widget-text-editor\" data-id=\"30269d3\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div><table><thead><tr><th>Ratio<\/th><th>Signification<\/th><th>Conduite<\/th><\/tr><\/thead><tbody><tr><td>&lt; 0,5<\/td><td>HO neurog\u00e8ne (dysautonomie)<\/td><td>Traitement presseur<\/td><\/tr><tr><td>\u2265 0,5<\/td><td>HO par hypovol\u00e9mie ou bas d\u00e9bit<\/td><td>R\u00e9hydratation \/ Ajustement traitement cardiaque<\/td><\/tr><\/tbody><\/table><\/div><p><em>Limites : non interpr\u00e9table en fibrillation atriale ou sous b\u00eatabloquants.<\/em><\/p><p><strong>Exemple clinique :<\/strong><\/p><ul><li>Couch\u00e9 : PA 139\/61 mmHg, FC 71 bpm<\/li><li>Debout 3 min : PA 89\/42 mmHg, FC 74 bpm<\/li><li>\u0394FC = 3 bpm ; \u0394PAS = 50 mmHg \u2192\u00a0<strong>Ratio = 0,06<\/strong>\u00a0\u2192 HO neurog\u00e8ne confirm\u00e9e<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b2e9ab5 elementor-widget elementor-widget-heading\" data-id=\"b2e9ab5\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Interpr\u00e9tation<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1972983 elementor-widget elementor-widget-text-editor\" data-id=\"1972983\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<table width=\"638\"><tbody><tr><td width=\"87\">Ratio<\/td><td width=\"224\">Signification<\/td><td width=\"327\">Prise en charge<\/td><\/tr><tr><td width=\"87\">&lt; 0,5<\/td><td width=\"224\">HO neurog\u00e8ne (dysautonomie)<\/td><td width=\"327\">Traitement presseur<\/td><\/tr><tr><td width=\"87\">\u2265 0,5<\/td><td width=\"224\">HO par hypovol\u00e9mie ou bas d\u00e9bit<\/td><td width=\"327\">R\u00e9hydratation \/ Ajustement traitement cardiaque<\/td><\/tr><\/tbody><\/table><p class=\"p1\"><b>Limites<\/b> : Stimulo-d\u00e9pendant, fibrillation atriale, b\u00e9tabloquants<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6a3be80 elementor-widget elementor-widget-heading\" data-id=\"6a3be80\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">D\u00e9finir la s\u00e9v\u00e9rit\u00e9 - \u00e9tape obligatoire<\/h5>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-33ab6bc elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"33ab6bc\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-6f31875\" data-id=\"6f31875\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-da0cc88 elementor-widget elementor-widget-heading\" data-id=\"da0cc88\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">HO S\u00c9V\u00c8RE<\/h5>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e29c1e1 elementor-widget elementor-widget-text-editor\" data-id=\"e29c1e1\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>HO s\u00e9v\u00e8re<\/strong>\u00a0Malaises s\u00e9v\u00e8res et\/ou syncopes au lever. Patient capable de tenir debout avec aide et traitement. Risque \u00e9lev\u00e9 de chute, major\u00e9 la nuit (nycturie + syncope post-mictionnelle).<\/p><p><strong>HO tr\u00e8s s\u00e9v\u00e8re<\/strong>\u00a0Syncope d\u00e8s la mise debout, parfois en position assise. Confinement au lit temporaire jusqu&rsquo;\u00e0 stabilisation. Hospitalisation n\u00e9cessaire.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-1cf7698\" data-id=\"1cf7698\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-362f1ec elementor-widget elementor-widget-heading\" data-id=\"362f1ec\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h5 class=\"elementor-heading-title elementor-size-default\">HO TR\u00c8S S\u00c9V\u00c8RE<\/h5>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-793afa0 elementor-widget elementor-widget-text-editor\" data-id=\"793afa0\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\">Syncope d\u00e8s mise debout<\/p><p class=\"p1\">Parfois syncope m\u00eame assis<\/p><p class=\"p1\"><b>Confinement au lit temporaire<\/b> jusqu&rsquo;\u00e0 stabilisation<\/p><p class=\"p1\">N\u00e9cessite hospitalisation<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-abe7ba8 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"abe7ba8\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-bb15b0e\" data-id=\"bb15b0e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-906ed91 elementor-widget elementor-widget-heading\" data-id=\"906ed91\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Hypertension neurog\u00e8ne de d\u00e9cubitus (nSH)<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-022013f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"022013f\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-d580a4b\" data-id=\"d580a4b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6ace220 elementor-widget elementor-widget-heading\" data-id=\"6ace220\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">D\u00e9finition (consensus AAS\/EFAS, Fanciulli et al. 2018) <\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-01bca5f elementor-widget elementor-widget-text-editor\" data-id=\"01bca5f\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>PAS \u2265 140 mmHg et\/ou PAD \u2265 90 mmHg apr\u00e8s \u2265 5 minutes en d\u00e9cubitus.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-841735c\" data-id=\"841735c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-359333a elementor-widget elementor-widget-heading\" data-id=\"359333a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Cons\u00e9quences<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4442206 elementor-widget elementor-widget-text-editor\" data-id=\"4442206\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><img loading=\"lazy\" decoding=\"async\" class=\"an1\" src=\"https:\/\/fonts.gstatic.com\/s\/e\/notoemoji\/17.0\/26a0_fe0f\/72.png\" alt=\"\u26a0\ufe0f\" width=\"24\" height=\"24\" data-emoji=\"\u26a0\ufe0f\" aria-label=\"\u26a0\ufe0f\" \/>\u00a0La nSH\u00a0<strong>ne doit jamais \u00eatre trait\u00e9e comme une HTA essentielle<\/strong>. Tout traitement antihypertenseur classique aggrave l&rsquo;HO matinale.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-12a5b12\" data-id=\"12a5b12\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e782b1d elementor-widget elementor-widget-heading\" data-id=\"e782b1d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Gestion<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d78616c elementor-widget elementor-widget-text-editor\" data-id=\"d78616c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li class=\"p1\">Horaire midodrine adapt\u00e9 (arr\u00eat 3-4h avant coucher)<\/li><li class=\"p1\">Inclinaison t\u00eate de lit 10-15\u00b0<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c8b99d1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c8b99d1\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-aaa1e11\" data-id=\"aaa1e11\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cffaf37 elementor-widget elementor-widget-heading\" data-id=\"cffaf37\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Prise en Charge Th\u00e9rapeutique<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f9e70f0 elementor-widget elementor-widget-heading\" data-id=\"f9e70f0\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Mesures non pharmacologiques (FONDAMENTALES)<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7ab9b25 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7ab9b25\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-c8df934\" data-id=\"c8df934\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-99beb17 elementor-widget elementor-widget-heading\" data-id=\"99beb17\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Bas de contention<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7877ded elementor-widget elementor-widget-text-editor\" data-id=\"7877ded\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Classe II (force 2)<\/b> mi-cuisse ou collant<\/p><p class=\"p1\">Mise en place <b>AVANT le premier lever<\/b><\/p><p class=\"p1\"><strong>et port\u00e9s 24h\/24 dans les formes s\u00e9v\u00e8res.<\/strong><\/p><p class=\"p1\">Alternative si intol\u00e9rance : ceinture abdominale<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-026503f\" data-id=\"026503f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d816e8f elementor-widget elementor-widget-heading\" data-id=\"d816e8f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Lever progressif<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a353e97 elementor-widget elementor-widget-text-editor\" data-id=\"a353e97\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Protocole en 3 \u00e9tapes<\/b> :<\/p><p class=\"p1\">1. Allong\u00e9 \u2192 pause 30 sec<\/p><p class=\"p1\">2. Assis bord du lit \u2192 pause 1 min<\/p><p class=\"p1\">3. Debout avec appui \u2192 surveillance 5-10 min<\/p><p class=\"p1\"><span class=\"s1\">\u26a0\ufe0f<\/span> <b>Attendre au minimum 1h apr\u00e8s la prise de midodrine<\/b>\u00a0(phase ON).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-bf590ff\" data-id=\"bf590ff\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-238da84 elementor-widget elementor-widget-heading\" data-id=\"238da84\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Inclinaison t\u00eate de lit 10-15\u00b0<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-abfde11 elementor-widget elementor-widget-text-editor\" data-id=\"abfde11\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>B\u00e9n\u00e9fices majeurs<\/b> :<\/p><p class=\"p1\">r\u00e9duction de l&rsquo;HTA de d\u00e9cubitus nocturne, diminution de la natriur\u00e8se et de la nycturie, am\u00e9lioration de l&rsquo;HO matinale.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9533b2c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9533b2c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-4fd2030\" data-id=\"4fd2030\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6491ea8 elementor-widget elementor-widget-image\" data-id=\"6491ea8\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/Mesures-non-pharmacologiques-amylose-cardiaque-1024x683.png\" class=\"attachment-large size-large wp-image-7723\" alt=\"Mesures non pharmacologiques-amylose-cardiaque\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/Mesures-non-pharmacologiques-amylose-cardiaque-1024x683.png 1024w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/Mesures-non-pharmacologiques-amylose-cardiaque-300x200.png 300w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/Mesures-non-pharmacologiques-amylose-cardiaque-768x512.png 768w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/Mesures-non-pharmacologiques-amylose-cardiaque.png 1536w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-fc16bf4\" data-id=\"fc16bf4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-163078c elementor-widget elementor-widget-heading\" data-id=\"163078c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Hydratation et nutrition<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-27f3e51 elementor-widget elementor-widget-text-editor\" data-id=\"27f3e51\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li>Hydratation renforc\u00e9e (\u00e0 adapter selon le degr\u00e9 de cardiopathie)<\/li><li>500 mL d&rsquo;eau rapidement : effet pressif rapide (man\u0153uvre de \u00ab rescue \u00bb)<\/li><li>Petits repas fr\u00e9quents, moins glucidiques<\/li><li>\u00c9viter l&rsquo;alcool (effet vasodilatateur)<\/li><li>Suppl\u00e9mentation sod\u00e9e selon avis cardiologique<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-537a0a7\" data-id=\"537a0a7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9a51bb2 elementor-widget elementor-widget-heading\" data-id=\"9a51bb2\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">R\u00e9habilitation<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d426195 elementor-widget elementor-widget-text-editor\" data-id=\"d426195\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ul><li class=\"p1\">P\u00e9dalier de lit,<\/li><li class=\"p1\">exercices en position assise ou couch\u00e9e.<\/li><li class=\"p1\">\u00c9viter la station debout prolong\u00e9e.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-423c653 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"423c653\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7c4b716\" data-id=\"7c4b716\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-55d3b3f elementor-widget elementor-widget-heading\" data-id=\"55d3b3f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Traitement pharmacologique<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-79175d2 elementor-widget elementor-widget-heading\" data-id=\"79175d2\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">MIDODRINE (GUTRON\u00ae) - Traitement de premi\u00e8re ligne<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d1b7416 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d1b7416\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-384c1e3\" data-id=\"384c1e3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ea84e63 elementor-widget elementor-widget-text-editor\" data-id=\"ea84e63\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Pharmacologie<\/b> :<\/p><p class=\"p1\">Demi-vie : ~3 heures<\/p><p class=\"p1\">D\u00e9lai d&rsquo;action : 45-60 minutes<\/p><p class=\"p1\">Dur\u00e9e d&rsquo;action : 3-4 heures<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-71a4143\" data-id=\"71a4143\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c766ade elementor-widget elementor-widget-text-editor\" data-id=\"c766ade\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Posologie<\/b> :<\/p><p class=\"p1\">Initiation : 2,5 mg \u00d7 4\/jour<\/p><p class=\"p1\">Titration : toutes les 24-48h<\/p><p class=\"p1\">Maximum : 10 mg \u00d7 4\/jour (40 mg\/jour)<\/p><p class=\"p1\">\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-6949b6a\" data-id=\"6949b6a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3949ea4 elementor-widget elementor-widget-text-editor\" data-id=\"3949ea4\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Horaires types<\/b> : 7h \/ 10h \/ 13h \/ 16h<\/p><p class=\"p1\"><b>Derni\u00e8re prise \u2265 3-4h avant coucher<\/b> (limite nSH)<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-cd91421 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"cd91421\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-c7b05d7\" data-id=\"c7b05d7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-1992d1b\" data-id=\"1992d1b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-26d138a elementor-widget elementor-widget-text-editor\" data-id=\"26d138a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><span class=\"s1\">\u26a1<\/span><b> Concept EFFET ON\/OFF<\/b> :<\/p><p class=\"p1\"><strong>Prise \u2192 OFF (0-45 min) \u2192 Transition (45-60 min) \u2192 ON (1-4h) \u2192 OFF (&gt;4h)<\/strong><\/p><p class=\"p1\"><b>Cons\u00e9quence pratique<\/b> : Lever uniquement en phase ON (\u22651h post-prise)<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-0090a79\" data-id=\"0090a79\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d38749e elementor-widget elementor-widget-text-editor\" data-id=\"d38749e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p><strong>Pr\u00e9cautions :<\/strong>\u00a0surveillance TA couch\u00e9e, risque de bradycardie r\u00e9flexe.\u00a0<\/p><p><strong>Contre-indications :<\/strong>\u00a0HTA s\u00e9v\u00e8re non contr\u00f4l\u00e9e, r\u00e9tention urinaire.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-a77cf13\" data-id=\"a77cf13\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-bfb7efa elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"bfb7efa\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-908cac8\" data-id=\"908cac8\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1cb6c2a elementor-widget elementor-widget-heading\" data-id=\"1cb6c2a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">FLUDROCORTISONE (FLUCORTAC\u00ae) - Traitement adjuvant<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2647b2c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2647b2c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-1cdfccf\" data-id=\"1cdfccf\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9bea830 elementor-widget elementor-widget-text-editor\" data-id=\"9bea830\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Posologie<\/b> :<\/p><p class=\"p1\">Initiation : 50 \u00b5g\/jour<\/p><p class=\"p2\">Prise \u2192 OFF (0-45 min) \u2192 Transition (45-60 min) \u2192 ON (1-4h) \u2192 OFF (&gt;4h)<\/p><p class=\"p2\"><span class=\"s1\">Dose usuelle : 100-200 \u00b5g\/jour<\/span><\/p><p class=\"p1\">Prise vesp\u00e9rale<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-935f55c\" data-id=\"935f55c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4915351 elementor-widget elementor-widget-text-editor\" data-id=\"4915351\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Surveillance<\/b> :<\/p><p class=\"p1\">Kali\u00e9mie (risque d&rsquo;hypokali\u00e9mie)<\/p><p class=\"p1\">Poids, \u0153d\u00e8mes (r\u00e9tention hydrosod\u00e9e)<\/p><p class=\"p1\">TA couch\u00e9e (aggravation nSH)<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-ca3919f\" data-id=\"ca3919f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2ab285d elementor-widget elementor-widget-text-editor\" data-id=\"2ab285d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Pr\u00e9cautions<\/b> :<\/p><p class=\"p1\">\u00c9viter en cas d&rsquo;insuffisance cardiaque droite s\u00e9v\u00e8re ou d&rsquo;\u0153d\u00e8mes\/ascite<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-cf05d05 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"cf05d05\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-32d30b3\" data-id=\"32d30b3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-976edc5 elementor-widget elementor-widget-heading\" data-id=\"976edc5\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">DROXIDOPA (DOPS OD\u00ae) - ATU - En cas d'\u00e9chec ou d'intol\u00e9rance<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-9ac99a8 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"9ac99a8\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-e62129b\" data-id=\"e62129b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-27a0b1c elementor-widget elementor-widget-text-editor\" data-id=\"27a0b1c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Indications<\/b> :<\/p><p class=\"p1\">\u00c9chec midodrine \u00b1 fludrocortisone<\/p><p class=\"p1\">Intol\u00e9rance midodrine<\/p><p class=\"p1\">Association \u00e0 la midodrine dans les formes tr\u00e8s s\u00e9v\u00e8res &#8211; milieu sp\u00e9cialis\u00e9<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-396b653\" data-id=\"396b653\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ca88d33 elementor-widget elementor-widget-text-editor\" data-id=\"ca88d33\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Posologie<\/b> :<\/p><p class=\"p1\">Initiation : 100 mg \u00d7 3\/jour<\/p><p class=\"p1\">Titration progressive<\/p><p class=\"p1\">Maximum : 600 mg \u00d7 3\/jour (1800 mg\/jour)<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-e100314\" data-id=\"e100314\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0257a0e elementor-widget elementor-widget-text-editor\" data-id=\"0257a0e\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Surveillance<\/b> : HTA couch\u00e9e, c\u00e9phal\u00e9es<\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udccb<\/span> <b>Formulaire ATU disponible<\/b> sur www.reseau-amylose.org<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-df08ff6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"df08ff6\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8f22771\" data-id=\"8f22771\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d3bfef1 elementor-widget elementor-widget-heading\" data-id=\"d3bfef1\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Adaptation des traitements cardiovasculaires<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1319b60 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1319b60\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-4bbf8bd\" data-id=\"4bbf8bd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6ecf2ee elementor-widget elementor-widget-text-editor\" data-id=\"6ecf2ee\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>\u00c0 supprimer ou adapter en concertation avec le cardiologue r\u00e9f\u00e9rent<\/b>\u00a0<\/p><p class=\"p1\"><span class=\"s1\">\u274c<\/span> Hypotenseurs<\/p><p class=\"p1\"><span class=\"s1\">\u274c<\/span> Vasodilatateurs<\/p><p class=\"p1\"><span class=\"s1\">\u26a0\ufe0f<\/span> Diur\u00e9tiques si possible (\u00e0 peser selon le degr\u00e9 d&rsquo;insuffisance cardiaque)<\/p><p class=\"p1\"><span class=\"s1\">\u26a0\ufe0f<\/span> B\u00e9tabloquants<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-acc7461\" data-id=\"acc7461\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-40c9102 elementor-widget elementor-widget-text-editor\" data-id=\"40c9102\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Pacemaker<\/b> :<\/p><p class=\"p1\">Acc\u00e9l\u00e9ration FC de repos selon la gravit\u00e9<\/p><p class=\"p1\">Effet isol\u00e9 probablement\u00a0limit\u00e9<\/p><p class=\"p1\">En compl\u00e9ment des autres mesures<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-52f01cb elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"52f01cb\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-43ec7bd\" data-id=\"43ec7bd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6c8ef9e elementor-widget elementor-widget-heading\" data-id=\"6c8ef9e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">S\u00e9curit\u00e9 hospitali\u00e8re \u2014 Protocole et pr\u00e9vention des chutes\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-fc88f02 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"fc88f02\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-22915f5\" data-id=\"22915f5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-66 elementor-top-column elementor-element elementor-element-22e8e29\" data-id=\"22e8e29\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fa22317 elementor-widget elementor-widget-image\" data-id=\"fa22317\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"768\" height=\"1152\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/04\/ChatGPT-Image-9-avr.-2026-12_44_02-1-768x1152.png\" class=\"attachment-medium_large size-medium_large wp-image-7880\" alt=\"check-list-hypotension-orthostatique-amylose-cardiaque\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/04\/ChatGPT-Image-9-avr.-2026-12_44_02-1-768x1152.png 768w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/04\/ChatGPT-Image-9-avr.-2026-12_44_02-1-200x300.png 200w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/04\/ChatGPT-Image-9-avr.-2026-12_44_02-1-683x1024.png 683w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/04\/ChatGPT-Image-9-avr.-2026-12_44_02-1.png 1024w\" sizes=\"(max-width: 768px) 100vw, 768px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-16 elementor-top-column elementor-element elementor-element-f01b950\" data-id=\"f01b950\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a9618c1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a9618c1\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ab5803e\" data-id=\"ab5803e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0390598 elementor-widget elementor-widget-heading\" data-id=\"0390598\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Brancardage et examens (POINT CRITIQUE)<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b1919a6 elementor-widget elementor-widget-text-editor\" data-id=\"b1919a6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>L&rsquo;infirmier(e) doit syst\u00e9matiquement pr\u00e9venir le brancardier et l&rsquo;\u00e9quipe d&rsquo;examen (scanner, IRM, \u00e9chographie, endoscopie) :<\/p><blockquote><p><em>\u00ab Patient HO s\u00e9v\u00e8re \u2013 Risque syncope \u2013 Ne pas lever sans bas + d\u00e9lai 1h post-Gutron\u00ae \u2013 Transfert assist\u00e9 \u00bb<\/em><\/p><\/blockquote><p><img loading=\"lazy\" decoding=\"async\" class=\"an1\" src=\"https:\/\/fonts.gstatic.com\/s\/e\/notoemoji\/17.0\/26a0_fe0f\/72.png\" alt=\"\u26a0\ufe0f\" width=\"31\" height=\"31\" data-emoji=\"\u26a0\ufe0f\" aria-label=\"\u26a0\ufe0f\" \/>\u00a0Le risque est maximal au\u00a0<strong>retour de salle<\/strong>\u00a0(fatigue + hypovol\u00e9mie cumul\u00e9e).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f947464 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f947464\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-85abaaf\" data-id=\"85abaaf\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3105bcc elementor-widget elementor-widget-heading\" data-id=\"3105bcc\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Affichage en chambre<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ccbc894 elementor-widget elementor-widget-text-editor\" data-id=\"ccbc894\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\">Outil de s\u00e9curit\u00e9 essentiel : affiche visible \u00e0 l&rsquo;entr\u00e9e de la chambre indiquant la s\u00e9v\u00e9rit\u00e9 (HO s\u00e9v\u00e8re vs tr\u00e8s s\u00e9v\u00e8re), les consignes de lever et les horaires de prise de midodrine.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-911911b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"911911b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6299a3e\" data-id=\"6299a3e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-872f812 elementor-widget elementor-widget-heading\" data-id=\"872f812\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">\u00c9ducation th\u00e9rapeutique du patient et des aidants<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-643035b elementor-widget elementor-widget-heading\" data-id=\"643035b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Objectif : Patient et aidants ACTEURS<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-62c69d7 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"62c69d7\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7f4abe7\" data-id=\"7f4abe7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-39b5eff elementor-widget elementor-widget-text-editor\" data-id=\"39b5eff\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>L&rsquo;objectif est de rendre le patient et ses aidants\u00a0<strong>acteurs de leur s\u00e9curit\u00e9<\/strong>. Le patient doit pouvoir communiquer spontan\u00e9ment avec tout soignant :<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-45baf56 elementor-widget elementor-widget-text-editor\" data-id=\"45baf56\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><span class=\"s1\">\ud83d\udcac<\/span> <i>\u00ab\u00a0Je ne peux pas \u00eatre lev\u00e9 sans mes bas et sans d\u00e9lai apr\u00e8s la midodrine\u00a0\u00bb<\/i><\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udcac<\/span> <i>\u00ab\u00a0Je peux faire une syncope si on me met debout trop vite\u00a0\u00bb<\/i><\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udcac<\/span> <i>\u00ab\u00a0Je dois \u00eatre accompagn\u00e9 la nuit\u00a0\u00bb<\/i><\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udcac<\/span> <i>\u00ab\u00a0Ne modifiez pas mon traitement sans l&rsquo;accord de mon \u00e9quipe amylose\u00a0\u00bb<\/i><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1a2386e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1a2386e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-6123f1c\" data-id=\"6123f1c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d1b0647 elementor-widget elementor-widget-heading\" data-id=\"d1b0647\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Complications, impact pronostique et qualit\u00e9 de vie<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d4aa4aa elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d4aa4aa\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-fb1aa4a\" data-id=\"fb1aa4a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ae4c02f elementor-widget elementor-widget-heading\" data-id=\"ae4c02f\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Impact clinique<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2764c0b elementor-widget elementor-widget-text-editor\" data-id=\"2764c0b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>\u00c0 court terme<\/b> :<\/p><p>Chutes et traumatismes (risque major\u00e9 sous anticoagulants),<\/p><p>Mort subite par d\u00e9samor\u00e7age de la pompe,<\/p><p>D\u00e9c\u00e8s.<\/p><p class=\"p1\"><b>\u00c0 long terme<\/b> :<\/p><p>Perte d&rsquo;autonomie,<\/p><p>Impossibilit\u00e9 de verticalisation,<\/p><p>Alitement,<\/p><p>D\u00e9conditionnement,<\/p><p>D\u00e9nutrition,<\/p><p>Hospitalisations r\u00e9p\u00e9t\u00e9es.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-0333780\" data-id=\"0333780\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-01614b6 elementor-widget elementor-widget-heading\" data-id=\"01614b6\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Impact sur la survie<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1884ada elementor-widget elementor-widget-text-editor\" data-id=\"1884ada\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Donn\u00e9es r\u00e9centes<\/b> :<\/p><p class=\"p1\">L&rsquo;HO impacte significativement la survie dans l&rsquo;amylose AL, notamment en pr\u00e9sence d&rsquo;un syndrome n\u00e9phrotique associ\u00e9 \u00e0 une atteinte cardiaque (Sakhi et al., Amyloid 2025).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-36a7b34 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"36a7b34\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ef617b5\" data-id=\"ef617b5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f550c1b elementor-widget elementor-widget-heading\" data-id=\"f550c1b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Erreurs Fr\u00e9quentes \u00e0 \u00c9viter en pratique clinique<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5e5b137 elementor-widget elementor-widget-text-editor\" data-id=\"5e5b137\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<table width=\"473\"><tbody><tr><td style=\"text-align: left\" width=\"249\"><strong>ERREUR<\/strong><\/td><td width=\"224\"><strong>CONS\u00c9QUENCES<\/strong><\/td><\/tr><tr><td>Mesurer uniquement TA couch\u00e9e<\/td><td>Sous-diagnostic et sous-traitement<\/td><\/tr><tr><td>Lever &lt; 1h apr\u00e8s GUTRON\u00ae<\/td><td>Chute (effet OFF)<\/td><\/tr><tr><td>Bas non mis ou mal adapt\u00e9s<\/td><td>Chute<\/td><\/tr><tr><td>Traiter l&rsquo;HTA couch\u00e9e comme une HTA essentielle<\/td><td>Aggravation majeure HO<\/td><\/tr><tr><td>Omettre l&rsquo;\u00e9pisode diarrh\u00e9ique\/vomissement<\/td><td>D\u00e9shydratation \u2192 chute<\/td><\/tr><tr><td>Lever nocturne non assist\u00e9<\/td><td>Syncope post-mictionnelle<\/td><\/tr><tr><td>Arr\u00eater GUTRON\u00ae si patient \u00e0 jeun<\/td><td>Effet OFF \u2192 chute<\/td><\/tr><\/tbody><\/table>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b747841 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b747841\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4221056\" data-id=\"4221056\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a34d20e elementor-widget elementor-widget-heading\" data-id=\"a34d20e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Cas Particuliers<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e0acafc elementor-widget elementor-widget-heading\" data-id=\"e0acafc\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Anesth\u00e9sie et dysautonomie s\u00e9v\u00e8re<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-c1d112e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"c1d112e\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-9b0352f\" data-id=\"9b0352f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e2fd18c elementor-widget elementor-widget-text-editor\" data-id=\"e2fd18c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Risques majeurs<\/b> :<\/p><p class=\"p1\">Hypotension per-op\u00e9ratoire s\u00e9v\u00e8re<\/p><p class=\"p1\">Allongement QT et isch\u00e9mie<\/p><p class=\"p1\">R\u00e9ponse diminu\u00e9e \u00e0 hypox\u00e9mie\/hypercapnie<\/p><p class=\"p1\">Atropine souvent inefficace<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-3bfa367\" data-id=\"3bfa367\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-410d667 elementor-widget elementor-widget-text-editor\" data-id=\"410d667\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><strong>Pr\u00e9cautions :<\/strong><\/p><p class=\"p1\">Information anesth\u00e9siste ++<\/p><p class=\"p1\">Maintien midodrine jusqu&rsquo;au bloc<\/p><p class=\"p1\">Monitoring invasif<\/p><p class=\"p1\">Vasopresseurs disponibles<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-15d242f\" data-id=\"15d242f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d337c07 elementor-widget elementor-widget-heading\" data-id=\"d337c07\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Transplantation cardiaque<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4031423 elementor-widget elementor-widget-text-editor\" data-id=\"4031423\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\">La dysautonomie s\u00e9v\u00e8re peut constituer une <b>contre-indication relative<\/b> \u00e0 la greffe cardiaque.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-490321d elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"490321d\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-9c41a41\" data-id=\"9c41a41\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7679776 elementor-widget elementor-widget-heading\" data-id=\"7679776\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Transplantation cardiaque<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-803bc10 elementor-widget elementor-widget-text-editor\" data-id=\"803bc10\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>La dysautonomie s\u00e9v\u00e8re peut constituer une contre-indication relative \u00e0 la greffe cardiaque. [\u00c0 V\u00c9RIFIER PAR L&rsquo;\u00c9QUIPE : crit\u00e8res pr\u00e9cis selon les centres]<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3e925ba elementor-widget elementor-widget-heading\" data-id=\"3e925ba\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Quand Contacter le Centre de R\u00e9f\u00e9rence ?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-efd38bf elementor-widget elementor-widget-heading\" data-id=\"efd38bf\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Situations n\u00e9cessitant avis sp\u00e9cialis\u00e9<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0f2b5e2 elementor-widget elementor-widget-text-editor\" data-id=\"0f2b5e2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<table width=\"473\"><tbody><tr><td width=\"249\"><strong>SITUATION<\/strong><\/td><td width=\"224\"><strong>D\u00c9LAI<\/strong><\/td><\/tr><tr><td>HO tr\u00e8s s\u00e9v\u00e8re (syncope d\u00e8s lever)<\/td><td>48h<\/td><\/tr><tr><td>Syncopes quotidiennes<\/td><td>48h<\/td><\/tr><tr><td>Chutes r\u00e9p\u00e9t\u00e9es malgr\u00e9 traitement<\/td><td>1 semaine<\/td><\/tr><tr><td>Aggravation brutale<\/td><td>Urgent<\/td><\/tr><tr><td>Impossibilit\u00e9 tenir debout\/assis<\/td><td>24h<\/td><\/tr><tr><td>Diarrh\u00e9es\/vomissements persistants<\/td><td>2-3 jours<\/td><\/tr><\/tbody><\/table>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c7faf53 elementor-widget elementor-widget-text-editor\" data-id=\"c7faf53\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\" style=\"text-align: center\"><b>Contact<\/b> :<\/p><p class=\"p1\" style=\"text-align: center\">Centre de R\u00e9f\u00e9rence Amylose Cardiaque &#8211; CHU Henri Mondor<\/p><p class=\"p1\" style=\"text-align: center\"><span class=\"s1\">\ud83d\udcde<\/span> <b>01.49.81.22.53<\/b><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5d3277c elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5d3277c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-2849e0e\" data-id=\"2849e0e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-174f625 elementor-widget elementor-widget-heading\" data-id=\"174f625\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Algorithme D\u00e9cisionnel<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-af4dfa0 elementor-widget elementor-widget-image\" data-id=\"af4dfa0\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"683\" height=\"1024\" src=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/ChatGPT-Image-23-fevr.-2026-17_34_04-1-683x1024.png\" class=\"attachment-large size-large wp-image-7750\" alt=\"Algorithme-De\u0301cisionnel-hypotension-orthostatique-amylose-cardiaque\" srcset=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/ChatGPT-Image-23-fevr.-2026-17_34_04-1-683x1024.png 683w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/ChatGPT-Image-23-fevr.-2026-17_34_04-1-200x300.png 200w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/ChatGPT-Image-23-fevr.-2026-17_34_04-1-768x1152.png 768w, https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/ChatGPT-Image-23-fevr.-2026-17_34_04-1.png 1024w\" sizes=\"(max-width: 683px) 100vw, 683px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-7f77430\" data-id=\"7f77430\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c07eadb elementor-widget elementor-widget-heading\" data-id=\"c07eadb\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Ressources T\u00e9l\u00e9chargeables<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-96ee6fb elementor-widget elementor-widget-text-editor\" data-id=\"96ee6fb\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Pour les professionnels de sant\u00e9<\/b><\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udcc4<\/span> <a href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/check-list-hypotension-orthostatique-amylose-cardiaque.png\" target=\"_blank\" rel=\"noopener\"><b>Fiche protocole complet<\/b> (format PDF)<\/a><\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udcc4<\/span> <a href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/documentation\/triptyques-du-centre-de-reference-des-amyloses-cardiaques-chu-henri-mondor\/\" target=\"_blank\" rel=\"noopener\"><b>Triptyque \u00ab\u00a0Prise en charge de l&rsquo;HO dans l&rsquo;amylose\u00a0\u00bb<\/b><\/a><\/p><p class=\"p1\"><b><span class=\"s1\">\ud83d\udcc4<\/span> Affiche chambre<\/b> (<a href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/Affiche-chambre-HS.png\" target=\"_blank\" rel=\"noopener\">HO s\u00e9v\u00e8re<\/a> \/ <a href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/Affiche-chambre-HT.png\" target=\"_blank\" rel=\"noopener\">HO tr\u00e8s s\u00e9v\u00e8re<\/a>)<\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udccb<\/span> <a href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/check-list-hypotension-orthostatique-amylose-cardiaque.png\" target=\"_blank\" rel=\"noopener\"><b>Check-list IDE\/AS<\/b><\/a><\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udccb<\/span> <b>Formulaire ATU Droxidopa<\/b><\/p><p class=\"p1\"><span class=\"s1\">\ud83c\udfa5<\/span> <b>Vid\u00e9o de formation<\/b> \u00ab\u00a0Les 6 gestes qui \u00e9vitent une chute\u00a0\u00bb<\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udcca<\/span> <a href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/Carte-Urgence-Dysautonomie-Vasculaire_Reseau-Amylose.pdf\" target=\"_blank\" rel=\"noopener\"><b>Pr\u00e9sentation PowerPoint<\/b> (support formation)<\/a><\/p><p class=\"p1\"><b>Pour les patients et aidants<\/b><\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udcc4<\/span> <a href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/04\/Fiche_Patient-Aidant_Amylose_HO_Visuelle_compressed.pdf\" target=\"_blank\" rel=\"noopener\"><b>Fiche patient\/aidant<\/b> \u00ab\u00a0Vivre avec une dysautonomie\u00a0\u00bb<\/a><\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udcb3<\/span> <a href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/wp-content\/uploads\/sites\/5\/2026\/02\/Carte-Urgence-Dysautonomie-Vasculaire_Reseau-Amylose.pdf\" target=\"_blank\" rel=\"noopener\"><b>Carte d&rsquo;urgence dysautonomie<\/b> (format CB)<\/a><\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udcd6<\/span> <b>Livret de suivi<\/b> (TA, sympt\u00f4mes, horaires)<\/p><p class=\"p1\"><span class=\"s1\">\ud83d\udcca<\/span> <a href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/documentation\/triptyques-du-centre-de-reference-des-amyloses-cardiaques-chu-henri-mondor\/\" target=\"_blank\" rel=\"noopener\"><b>Triptyque patient<\/b> \u00ab\u00a0Comprendre ma dysautonomie\u00a0\u00bb<\/a><\/p><p><span style=\"color: #800000\"><em><b>Tous les documents t\u00e9l\u00e9chargeables<\/b> sur www.reseau-amylose.org<\/em><\/span><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-43e0303 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"43e0303\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f2cc754\" data-id=\"f2cc754\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-af84f30 elementor-widget elementor-widget-heading\" data-id=\"af84f30\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">FAQ<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1909a2e elementor-widget elementor-widget-heading\" data-id=\"1909a2e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Comment d\u00e9finir une hypotension orthostatique dans l'amylose ?<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9bab628 elementor-widget elementor-widget-text-editor\" data-id=\"9bab628\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>L&rsquo;hypotension orthostatique est d\u00e9finie par une chute de la pression art\u00e9rielle systolique \u2265 20 mmHg ou diastolique \u2265 10 mmHg apr\u00e8s 3 minutes de station debout. Dans l&rsquo;amylose, elle est d&rsquo;origine neurog\u00e8ne : la nor\u00e9pin\u00e9phrine plasmatique ne s&rsquo;\u00e9l\u00e8ve pas \u00e0 l&rsquo;orthostatisme.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0596696 elementor-widget elementor-widget-heading\" data-id=\"0596696\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Comment diff\u00e9rencier une HO neurog\u00e8ne d'une HO par hypovol\u00e9mie ? <\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-12e0c10 elementor-widget elementor-widget-text-editor\" data-id=\"12e0c10\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Le ratio \u0394FC\/\u0394PAS permet de trancher : un ratio &lt; 0,5 bpm\/mmHg signe une HO neurog\u00e8ne (dysautonomie), tandis qu&rsquo;un ratio \u2265 0,5 oriente vers une hypovol\u00e9mie ou un bas d\u00e9bit cardiaque.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2a5c5a3 elementor-widget elementor-widget-heading\" data-id=\"2a5c5a3\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Quel est le traitement de premi\u00e8re intention de l'HO dans l'amylose cardiaque ?<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-90d8102 elementor-widget elementor-widget-text-editor\" data-id=\"90d8102\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>La midodrine (Gutron\u00ae) est le traitement presseur de premi\u00e8re ligne, \u00e0 initier \u00e0 2,5 mg \u00d7 4\/jour avec titration progressive. Elle doit \u00eatre prise au moins 1 heure avant tout lever (concept ON\/OFF). Les mesures non pharmacologiques (bas de contention, lever progressif, inclinaison du lit) sont indispensables et prioritaires.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a0b9aa2 elementor-widget elementor-widget-heading\" data-id=\"a0b9aa2\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Pourquoi ne faut-il pas traiter l'hypertension de d\u00e9cubitus de l'amylose comme une HTA essentielle ?<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9d08e65 elementor-widget elementor-widget-text-editor\" data-id=\"9d08e65\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>L&rsquo;hypertension nocturne en d\u00e9cubitus est un m\u00e9canisme compensatoire li\u00e9 \u00e0 la dysautonomie. La traiter par des antihypertenseurs classiques aggraverait l&rsquo;hypotension orthostatique matinale et exposerait le patient \u00e0 un risque de chute majeur.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f49f4f0 elementor-widget elementor-widget-heading\" data-id=\"f49f4f0\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Quand faut-il contacter le centre de r\u00e9f\u00e9rence amylose pour une HO ?<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3fe1fab elementor-widget elementor-widget-text-editor\" data-id=\"3fe1fab\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Un avis sp\u00e9cialis\u00e9 est requis en urgence (24-48h) en cas de syncopes au lever, d&rsquo;impossibilit\u00e9 de tenir debout ou d&rsquo;aggravation brutale. Des \u00e9pisodes de diarrh\u00e9es ou vomissements prolong\u00e9s n\u00e9cessitent \u00e9galement un contact dans les 2 \u00e0 3 jours.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a7abee6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a7abee6\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d555792\" data-id=\"d555792\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5ca8d5e elementor-widget elementor-widget-heading\" data-id=\"5ca8d5e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Bibliographie S\u00e9lective<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d24d0e6 elementor-widget elementor-widget-heading\" data-id=\"d24d0e6\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Publications r\u00e9centes - Dysautonomie dans l'amylose - 2025-2026<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-15a2df6 elementor-widget elementor-widget-text-editor\" data-id=\"15a2df6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Barocelli F et al.<\/b> The Vagal link: Autonomic Nervous System Dysfunction in Cardiac Amyloidosis. <i>J<\/i><\/p><p class=\"p1\"><i>Clin Med.<\/i> 2025;14(24):8963.<\/p><p class=\"p1\"><b>Iacovelli JJ et al.<\/b> Attenuated Peripheral Vascular Responsiveness in wtATTR. <i>Am J Physiol Heart Circ<\/i><\/p><p class=\"p1\"><i>Physiol.<\/i> 2026 Jan 30.<\/p><p class=\"p1\"><b>Weinsaft A et al.<\/b> Impact of autonomic dysfunction on cardiovascular outcomes in ATTR: insights from<\/p><p class=\"p1\">COMPASS-31. <i>Amyloid.<\/i> 2025;32(4):314-323.<\/p><p class=\"p1\"><b>Sakhi H et al.<\/b> Impact of autonomic dysfunction in light chain amyloidosis with nephrotic syndrome and<\/p><p class=\"p1\">cardiac involvement. <i>Amyloid.<\/i> 2025;32(4):371-374.<\/p><p class=\"p1\"><b>Poledniczek M et al.<\/b> Prevalence of Autonomic Dysfunction in Cardiac Amyloidosis. <i>J Clin Med.<\/i> 2025.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7b270c2 elementor-widget elementor-widget-heading\" data-id=\"7b270c2\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Consensus et guidelines<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a9f29d3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a9f29d3\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-107b048\" data-id=\"107b048\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-09db792 elementor-widget elementor-widget-text-editor\" data-id=\"09db792\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Fanciulli A et al.<\/b> Consensus statement on neurogenic supine hypertension (AAS\/EFAS). <i>Clin Auton Res.<\/i><\/p><p class=\"p1\">2018;28(4):355-362.<\/p><p class=\"p1\"><b>Palma JA et al.<\/b> Orthostatic hypotension in hereditary transthyretin amyloidosis: epidemiology, diagnosis<\/p><p class=\"p1\">and management. <i>Clin Auton Res.<\/i> 2019. PMID: 31452021.<\/p><p class=\"p1\"><b>Gonz\u00e1lez-Duarte A et al.<\/b> Blood pressure and orthostatic hypotension in THAOS. <i>Auton Neurosci.<\/i> 2019.<\/p><p class=\"p1\">PMID: 31726319.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-af67613 elementor-widget elementor-widget-heading\" data-id=\"af67613\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Traitements<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d1790dc elementor-widget elementor-widget-text-editor\" data-id=\"d1790dc\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\"><b>Valladares C et al.<\/b> Droxidopa in Critical Care: A Systematic Review. <i>Crit Care Res Pract.<\/i><\/p><p class=\"p1\">2025;2025:4830160.<\/p><p class=\"p1\"><b>McDonell KE et al.<\/b> Initiation of droxidopa for refractory neurogenic OH. <i>J Clin Hypertens.<\/i><\/p><p class=\"p1\">2019;21(9):1308-1314.<\/p><p class=\"p1\"><b>Ruiz Lopez JN et al.<\/b> Droxidopa for Refractory OH in AL Amyloidosis. <i>Blood.<\/i> 2021;138(Suppl 1):4737.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a9979b5 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a9979b5\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-eaeaf9a\" data-id=\"eaeaf9a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fec28ec elementor-widget elementor-widget-heading\" data-id=\"fec28ec\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Points Cl\u00e9s \u00e0 Retenir<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-30db8dd elementor-widget elementor-widget-text-editor\" data-id=\"30db8dd\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p class=\"p1\">1. <b>L&rsquo;HO = urgence fonctionnelle<\/b> avec impact majeur sur pronostic et qualit\u00e9 de vie<\/p><p class=\"p1\">2. <b>Ratio \u0394FC\/\u0394PAS &lt; 0,5<\/b> confirme l&rsquo;origine neurog\u00e8ne<\/p><p class=\"p1\">3. <b>D\u00e9finir la s\u00e9v\u00e9rit\u00e9<\/b> (s\u00e9v\u00e8re vs tr\u00e8s s\u00e9v\u00e8re) guide la prise en charge<\/p><p class=\"p1\">4. <b>Mesures non pharmacologiques<\/b> = fondamentales (bas, lever, lit inclin\u00e9)<\/p><p class=\"p1\">5. <b>GUTRON\u00ae : effet ON\/OFF<\/b> \u2192 lever uniquement \u22651h apr\u00e8s prise<\/p><p class=\"p1\">6. <b>HTA couch\u00e9e \u2260 HTA essentielle<\/b> \u2192 ne jamais traiter classiquement<\/p><p class=\"p1\">7. <b>La nuit = p\u00e9riode \u00e0 haut risque<\/b> (nycturie + syncope post-mictionnelle)<\/p><p class=\"p1\">8. <b>Brancardage\/examens = point critique<\/b> \u2192 pr\u00e9venir syst\u00e9matiquement<\/p><p class=\"p1\">9. <b>Patient acteur<\/b> \u2192 \u00e9ducation fondamentale<\/p><p class=\"p1\">10. <b>Protocole hospitalier strict<\/b> = pr\u00e9vention des chutes<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d24dd98 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d24dd98\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ab6aff7\" data-id=\"ab6aff7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-09d8994 elementor-widget elementor-widget-text-editor\" data-id=\"09d8994\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>L&rsquo;hypotension orthostatique (HO) neurog\u00e8ne est une complication fr\u00e9quente et grave des amyloses cardiaques, notamment dans les formes AL et ATTRv. Elle r\u00e9sulte de l&rsquo;infiltration amylo\u00efde des nerfs autonomes, abolissant la r\u00e9ponse sympathique \u00e0 l&rsquo;orthostatisme (nor\u00e9pin\u00e9phrine plasmatique basse, non r\u00e9active). Elle est associ\u00e9e \u00e0 un ph\u00e9notype labile caract\u00e9ristique : hypertension neurog\u00e8ne de d\u00e9cubitus nocturne (nSH) alternant avec une hypotension profonde au lever. Le diagnostic repose sur la mesure standardis\u00e9e de la pression art\u00e9rielle apr\u00e8s 3 minutes debout (crit\u00e8re : \u0394PAs \u2265 20 mmHg ou \u0394PAd \u2265 10 mmHg) et sur le ratio \u0394FC\/\u0394PAS (&lt; 0,5 = origine neurog\u00e8ne). La s\u00e9v\u00e9rit\u00e9 se classe en HO s\u00e9v\u00e8re (syncopes au lever) et HO tr\u00e8s s\u00e9v\u00e8re (syncope d\u00e8s la verticalisation). La prise en charge associe des mesures non pharmacologiques (bas de contention, lever progressif, inclinaison du lit) et un traitement pharmacologique presseur (midodrine en premi\u00e8re ligne, fludrocortisone en adjuvant, droxidopa en ATU). La midodrine suit un effet ON\/OFF : le lever doit \u00eatre r\u00e9alis\u00e9 \u2265 1h apr\u00e8s la prise. La nSH ne doit jamais \u00eatre trait\u00e9e comme une HTA essentielle. L&rsquo;impact pronostique est majeur : l&rsquo;HO aggrave la survie dans l&rsquo;amylose AL avec atteinte cardiaque (Sakhi et al., Amyloid 2025). Le site de r\u00e9f\u00e9rence francophone est\u00a0<a href=\"http:\/\/www.reseau-amylose.org\/\" target=\"_blank\" rel=\"noopener\" data-saferedirecturl=\"https:\/\/www.google.com\/url?q=http:\/\/www.reseau-amylose.org&amp;source=gmail&amp;ust=1774430186382000&amp;usg=AOvVaw27Lj3c8WrHhn11C0j_kRYu\">www.reseau-amylose.org<\/a>, rattach\u00e9 au Centre de R\u00e9f\u00e9rence Amylose Cardiaque du CHU Henri Mondor (APHP, Cr\u00e9teil).<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Dysautonomie Vasculaire et Hypotension Orthostatique dans l&rsquo;Amylose Cardiaque Comprendre, diagnostiquer et prendre en charge L&rsquo;hypotension orthostatique (HO) d&rsquo;origine neurog\u00e8ne est une complication fr\u00e9quente et grave des amyloses cardiaques, particuli\u00e8rement dans les formes AL et ATTRv. Elle peut constituer le sympt\u00f4me inaugural dans environ 10 % des cas, exposant les patients \u00e0 une errance diagnostique prolong\u00e9e. [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[],"tags":[],"class_list":["post-7704","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Dysautonomie Vasculaire et Hypotension Orthostatique dans l&#039;Amylose cardiaque - R\u00e9seau Amylose<\/title>\n<meta name=\"description\" content=\"Dysautonomie vasculaire et hypotension orthostatique dans l\u2019amylose cardiaque : diagnostic et prise en charge pratique pour les soignants.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/reseau-amylose.org\/jesuissoignant\/dysautonomie-vasculaire-hypotension-orthostatique-amylose-cardiaque-soignants\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Dysautonomie Vasculaire et Hypotension Orthostatique dans l&#039;Amylose cardiaque - 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