PVCs are a fairly normal thing. Sitting right here typing this out, I felt one, it’s kind of like your heart skips a beat. Usually they are benign, but when you have sustained bursts of sequential runs of PVCs as a nurse we need to do some research and know the reasons why your patient is having these.
First, ventricular bigeminy
Second, ventricular trigeminy.
In both cases above, the PVC is followed by a compensatory pause that allows the SA node to rest the cycle. Also, it appears that in each case, it is a single irritable foci that is firing as the complexes are the same in each strip. Among the causes of PVCs are: ischemia, hypoxia, hypokalemia, hypomagnesemia, hypercalcemia, digoxin, cocaine, alcohol, tobacco, cardiomyopathy, MI, mitral valve prolapse and several others. One of the old school nurses I worked with was saying how back in the day, anytime a patient had more than 6 PVCs a minute, they got started on a lidocaine drip. Not so much anymore.
If this were my patient, I would double check to make sure they’re maintaining a blood pressure and feeling OK, then make sure their electrolytes get checked. That is assuming there wasn’t some sort of event, like an MI, occurring. Typically treatment is either treat the underlying problem, like repleting electrolytes, or do nothing. Antiarrhythmic medications typically are not used as the side effects can be worse than the problem they are trying to treat! (See info on the CAST trial for a good illustration.)
The key comes down to this: how does your patient look? As with many arrhythmias, sometimes the true measure of what the squiggly lines are saying about your patient is what you patient is telling you. If they’re doing just fine, then no worries, if not, you need to do some digging!