Bigemini

A Premature Ventricular contraction (PVC) begins in the ventricle instead of the usual place, the sinus node in the Atrium. They are very common, and are sometimes perceived as a palpitation. They often occur without the patient being aware of it at all.

Bigeminy is the occurrence of a PVC every other beat. The main point with this type of arrhythmia is that the PVC’s are more frequent in these circumstances. They are otherwise little different from other PVC’s. If a recent change in rhythm has occurred, it should be checked out with some blood tests, an EKG and probably a Holter monitor test and a cardiac ECHO to check the heart function.

Normal conduction of the heart starts in the Atrium, after which the Ventricles contract and the process repeats itself:

And this is what it looks like on your EKG and the outside of your heart:

In patients with some types of heart disease, PVC’s or ventricular tachycardia do indicate an increased risk of serious arrhythmias.

Some cases are simply “normal variants”, occurring in otherwise normal individuals.

This is what a normal heart beat looks like on EKG:

This is what a Bigemini rhythm looks like (the arrow points to the PVC):

The general principles of treatment are:

• Correction of any underlying abnormalities, such as electrolyte imbalances, disorders of the thyroid, etc.
• Avoid stimulants or medications which may worsen the situation. Get enough sleep. Pursue an appropriate exercise program.
• Treat any underlying disorders of the heart appropriately.
• If the problem persists:

Consider medications for selected cases.

Some patients may benefit from a procedure called ablation.

Devices, such as implantable cardioverters or defibrillators are indicated only for those with very serious problems who are at risk of sudden death.