So I have been discussing an EKG for the last 40 min or so...and some time last night. I just thought I could put some thoughts together here since it isn't for school and then if anyone has feedback to offer please add! Below is the EKG and I can't make it bigger with it staying clear, which is unfortunate.
I am almost 100% sure this is bigeminy. Now, what you would do as a PT in this situation depends on how the patient and his EKG respond to exercise. In this case, he is getting it at the 3rd station of exercises, and his systolic BP has dropped over 30 points (if I remember correctly.) As far as why - I think it is because BP = CO x PVR. With a PVC, stroke volume decreases with each ectopic beat, decreasing CO (which = HR x SV) thus decreasing the BP. And so I would stop the exercise, keep an eye on his EKG as well as his symptoms and report the arrhythmia to the MD. I don't think in this case it is too out of the ordinary to see this, because, in the history I have not disclosed yet the patient is s/p an MI. Arrhythmias after an MI are more common for a few reasons. One is that an MI really changes the chemical balances within the heart, which can change the contractility. Another could be due to the area of the prior infarct. Perhaps conduction fibers were damaged/killed, perhaps changing automaticity or rhythmicity of the myocardial cells. I might not have the pathophysiology completely correct here, and certainly there is a great deal more, but this helped put my thoughts in order. Thanks Kate Grimes and Cardiopulm and SIM-ma'am.
Whew, bed time...
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