I voted yes, but looked again to see the patient does show signs of ischemia with the ST segment depression, in addition to an isolated PVC. (It's been awhile since I've looked at an EKG). So now I am a little more hesitant and would say it depends on how the EKG compares to a stress test and symptoms at the time of this degree of ST segment depression. Without a stress test and more information, I would be hesitant.
To be controversial and going against the current trend in practice, my feeling is that physical therapists
are moving toward more and more divergence from the concept of the rehabilitation team and concurrently to direct competition with physicians. To be the decision-maker for initiating exercise with a cardiac patient,
superseding the role of the patient's cardiologist or PCP, is to markedly increase the liability of the P.T. in
our ever-increasing litigious culture. The direction of our profession in recent years, as therapists take on
more responsibilities away from our stated roles as experts in movement disorders, researched-based
exercise science and applications, and advanced rehabilitative methodology - we will become more
and more vulnerable to intense pressure from organized medicine. Some of us truly believe that direct
competition with physicians is to be welcomed and fostered so that the profession can be finally be
separate from the "subservience" to "docs". Well, I did not become a P.T. to eventually be a direct
competitor to physicians. One earns the respect, collegiality, and professional responsibility with all
those striving to benefit the patient by the demonstration of our skills and the quality of our outcomes.
I enthusiastically salute the discipline, sacrifice, and achievement of the D.P.T.s of the physical therapists
today. But, I inject my words of caution going forward, to be careful what you wish for. I disagree for
many reasons the assumption of certain responsibilities, previously in the toolbox of the physician.
This trend, however well-intentioned by some, will ultimately cause our profession many problems.
The strip shows a jonctional rhythm, with a HR of 99 bpm, sign of ischemia (about 2 mm ST depression), and no visible HR variation with breathing; (is he already exercising?); one PVC during that period is not an abnormal finding, but I would definitely need to look at more leads and check patient's most recent lab values and clinical status to make a decision about his appropriatness for an active exercise program at this time.
I would hesitate to exercise and would need to know patient s/s. Appears to be evidence of ST depression which indicates ischemia, also PVC, could be isolated, but not known without a full 1 minute strip.
It appears to be a PVC. If indeed it is a PVC, and you have an otherwise structurally normal heart, then it is generally thought that the presence of the PVCs is not associated with an adverse prognosis. In an overwhelming majority of patients, especially those with a structurally normal heart, PVCs are benign. The word benign means the extra beats do not indicate heart disease or predict sudden demise. Most PTs would see this and immediately freak out and NOT exercise the patient. If the patient had no current symptoms (SOB, etc) no significant medical history, family history etc., then the therapist would not be negligent in providing the patient with exercise. The reality however, is that in this age of defensive medicine, I think you would find the majority of PTs (my guess is >80%) referring back to their PCP or cardiologist.
Looks like an isolated PVC to me. But I don't know what lead this is, and I am certainly not a cardiologist. So based solely on the ECG strip, I am not sure I can make a determination if it's safe for this patient to exercise.
If I doubt, I'd refer back to the PCP, or consult with a cardiologist regarding my questions on the issue.