What is the significance of trigeminy, bigeminy with couplets and triplets in a 55-year-old patient diagnosed with thrombosis and peripheral arterial disease (PAD), under the care of Dr. Chengat?

From the Guidelines

The patient should be immediately evaluated for cardiac arrhythmias, specifically trigeminy, bigeminy, couplets, and triplets, which represent potentially serious cardiac rhythm disturbances, and managed with antiplatelet therapy, such as low-dose aspirin, and possibly rivaroxaban, as indicated by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1. Given the patient's age and comorbidities of thrombosis and peripheral arterial disease (PAD), it is crucial to prioritize their cardiovascular risk reduction and management of PAD symptoms.

• Initial management should include assessment of electrolyte levels (particularly potassium and magnesium), thyroid function, and medication review for potential arrhythmogenic agents.
• If the patient is symptomatic (experiencing dizziness, chest pain, shortness of breath, or syncope), more urgent intervention may be needed.
• The combination of thrombosis and PAD suggests underlying atherosclerotic disease which may also affect coronary vessels, increasing the risk of cardiac complications from these arrhythmias.
• According to the 2024 lower extremity peripheral artery disease guideline-at-a-glance 1, single antiplatelet therapy is reasonable to reduce the risk of major adverse cardiovascular events (MACE) in patients with asymptomatic PAD, and low-dose rivaroxaban combined with low-dose aspirin is effective to reduce the risk of MACE and major adverse limb events (MALE) in patients with symptomatic PAD.
• The patient's treatment plan should be individualized, taking into account their specific clinical subset of PAD, and managed by a multispecialty care team, as recommended by the 2024 lower extremity peripheral artery disease guideline-at-a-glance 1.

From the Research

Patient Condition

The patient is 55 years old and has been diagnosed with thrombosis and PAD. The patient is experiencing trigemini, bigemini with couplets and triplets, as reported by the tele tech.

Relevant Studies

• The use of antiarrhythmic drugs can be challenging due to their narrow therapeutic window 2.
• Beta-blockers such as metoprolol succinate and carvedilol may not be effective in treating idiopathic, frequent, monomorphic premature ventricular contractions, with a high percentage of patients experiencing poor or proarrhythmic responses 3.
• Metoprolol CR can be effective in maintaining sinus rhythm when initiated before cardioversion and repeated cardioversion of atrial fibrillation 4.
• Metoprolol has been shown to have a protective effect on arrhythmia and heart rate variability in healthy people with 24 hours of sleep deprivation 5.

Potential Treatment Options

• The patient's attending doctor, Dr. Chengat, may consider the use of antiarrhythmic drugs, such as metoprolol, to treat the patient's arrhythmias.
• However, the patient's response to beta-blockers should be closely monitored due to the potential for poor or proarrhythmic responses 3.
• The patient's overall condition, including their thrombosis and PAD, should be taken into account when determining the best course of treatment.