Healthy hearts beat in a standard rhythm. After a heartbeat, there is a pause, and then another heartbeat. However, people with bigeminy have slightly irregular heart rhythms where an extra beat immediately follows each regular one. Each set of beats is like twins, which is where the term bigeminy originates: bi and gemini, which are Latin for “double” and “twins.”
For each standard heartbeat in a person with bigeminy, another one arrives slightly too quickly. Experts refer to the early beats as premature ventricular contractions (PVCs) if they originate from the heart’s ventricles, or premature atrial contractions (PACs) if they begin in the atria. A common ventricular bigeminy rhythm is a standard beat, PVC, a pause, another standard beat, and another PVC.
Many people never notice that they have bigeminy because they cannot feel any changes to their heartbeat. Those who do notice symptoms often describe the difference as a fluttering or pounding sensation. It is extremely common to become overly aware of one’s heart rate and worry that it is beating too quickly.
Bigeminy is a somewhat complex condition because its cause is not always clear. PVCs may occur due to outside influences such as drugs including caffeine, alcohol, or various cardiac issues. They interfere with the heart’s electrical impulses and interrupt the normal order of pumping. Bigeminy occurs as a result. Potential risk factors for bigeminy-causing PVCs are exercise, anxiety, hypertension, and heart disease.
Doctors will often use an electrocardiogram to diagnose bigeminy. The test records the pattern of heartbeats, so a physician can check the results for potential causes of the irregular rhythm. On an EKG, the presence and severity of bigeminy depend on the length of the P-P interval, the space between P waves, or the first waves in a standard EKG, and signal atrial contraction. Essentially, bigeminy depends on the length of time between each heart contraction or full heartbeat. This is the “rule of bigeminy.”
People without heart disease or who have no noticeable symptoms typically do not require treatment for bigeminy. Those who do need treatment may receive beta-blockers, medications that help relax the heart and lower blood pressure. Some doctors prescribe antiarrhythmic drugs to restore the heart’s standard, healthy rhythm. Quitting smoking, managing stress, and moderate exercise may also be beneficial, although people with bigeminy should get cleared by their doctor before starting an exercise program.
In very severe cases of bigeminy, doctors may opt to use cardiac ablation to correct the arrhythmia. To do this, they must first identify tissue that is triggering or sustaining the bigeminy. The surgeon inserts a long catheter through a vein or artery in the groin and threads it to the heart. Once there, they deliver extreme heat or cold to scar or destroy the responsible tissue.
The majority of people experience premature heart contractions at various points without any issues or complications. Despite this, continuous and serious bigeminy may raise the risk of developing other arrhythmias, including atrial fibrillation, which involves the upper chambers of the heart beating in a different pattern than the lower ones. This can cause blood to pool in the atria and form a clot, eventually leading to a stroke. Continuous arrhythmia may also cause the heart to overwork itself, resulting in enlargement or heart failure.
Trying to prevent bigeminy is often unrealistic because it is usually asymptomatic and can result from such a wide range of causes. However, there are a few risk factors for bigeminy that may also lead to more serious issues. These include smoking, sedentary lifestyles, and diets that are rich in sodium and fat. Stress and anxiety can also be precursors to the condition.
Bigeminy is similar to other irregular heart patterns, leading to some confusion with terms. Specifically, if every other beat is irregular, the pattern is bigeminal. However, if every third beat is irregular, it is trigeminal, and every fourth, quadrigeminal. If every fifth or more beat is irregular, most experts refer to the rhythm as occasional.
Bigeminy contrasts with couplets, a similar irregular heart rhythm. While bigeminy is the pairing of a standard and irregular beat, a couplet is a pairing of two irregular beats. A couplet can consist of any type of unusual beat, as long as they occur consecutively.
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