Pulsus bigeminus: Difference between revisions
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{{Medref|date=November 2021}} |
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[[File:CG Heart.gif|thumb|Heartbeat (normal)]] |
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'''Pulsus bigeminus''' is a cardiovascular phenomenon characterized by groups of two [[Cardiac cycle|heartbeats]] close together followed by a longer pause. The second pulse is weaker than the first. It is caused by premature contractions (see [[Premature atrial contraction]] or [[Premature ventricular contraction|ventricular]]), usually of the [[Ventricle (heart)|ventricles]], after every other beat, so called extrasystoles. It can be a sign of [[hypertrophic obstructive cardiomyopathy]] or of many other types of heart disease. It can also be an innocent and passing phenomenon. Digitalis toxicity can cause this type of phenomenon. |
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'''Pulsus bigeminus''' is a cardiovascular phenomenon characterized by groups of two [[Cardiac cycle|heartbeats]] close together followed by a longer pause. The second pulse is weaker than the first. Look for a pattern of what appears to be a relatively normal [[QRS complex]]es, each followed by a smaller, abnormal one. The smaller beat is palpated as either a missing or an extra beat, and on EKG resembles a [[Premature ventricular contraction|PVC]].<ref>{{cite journal|last=Anand|first=Nidhi |author2=Manish Anand |author3=Alok Vardhan Mathur |author4=Madhukar Maletha |author5=SK Ghildyal|title=Intra-operative ventricular bigeminy: Can retractor be a cause|journal=Journal of Anaesthesiology Clinical Pharmacology|date=2010-02-03|volume=26|issue=4|pages=569–570|doi=10.4103/0970-9185.74626 |url=http://www.joacp.org/article.asp?issn=0970-9185;year=2010;volume=26;issue=4;spage=569;epage=570;aulast=Anand|access-date=2012-05-16 |doi-access=free |pmid=21547204 |pmc=3087243 }}</ref> These PVCs appearing every other beat are also called extrasystoles. |
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This phenomenon can be a sign of [[hypertrophic obstructive cardiomyopathy]] or of many other types of heart disease (see list below). Other causes include digitalis toxicity, induction of anesthesia,<ref>{{cite journal|last=ROLLASON|first=WN|author2=D. J. HALL |title=Dysrhythmias during inhalational anaesthesia for oral surgery|journal=Anaesthesia|date=March 1973|volume=28|issue=2|pages=139–145|doi=10.1111/j.1365-2044.1973.tb00305.x|pmid=4144496 |doi-access=free}}</ref> placement of surgical instrumentation into the thorax or as a benign, temporary phenomenon. |
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In Pulsus Bigeminus not all of the conducted electrical activity will elicit sufficient ventricular contraction to produce a palpable pulse. This is important for two reasons. One, an ECG may give a ventricular contraction rate that does not correspond to the palpated pulse rate. Secondly, because not all beats are being conducted, patients may present with symptoms of low output heart failure, e.g. Dizziness, shortness of breath or hypotension, even with a normal ECG. |
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==Cause== |
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Causes Include: |
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# Electrolyte imbalance e.g. [[Hypokalemia|Hypo]] or [[hyperkalemia]] |
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# [[Hypothyroidism]] |
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# [[Betablocker]] therapy |
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# [[Digoxin]] |
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# [[Myocardial Infarction]] |
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# Destruction or degeneration of the [[Cardiac electrophysiology|cardiac conduction system]] or [[heart muscle cells]] |
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# Infection |
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A doctor can discriminate pulsus bigeminus from [[pulsus alternans]] by auscultating the heart. |
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==Management== |
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Management includes looking for and removing underlying cause, including medicines (such as a Calcium Channel blocker) and [[inotrope|inotropic]] therapy to return cardiac output back to normal. If highly symptomatic over a longer period ablation therapy may be the only viable option. |
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==See also== |
==See also== |
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* [[Pulsus bisferiens]] |
* [[Pulsus bisferiens]] |
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* [[Dicrotic pulse]] |
* [[Dicrotic pulse]] |
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== References == |
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{{reflist}} |
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{{Cardiovascular system symptoms and signs}} |
{{Cardiovascular system symptoms and signs}} |
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{{DEFAULTSORT:Pulsus Bigeminus}} |
{{DEFAULTSORT:Pulsus Bigeminus}} |
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[[Category:Cardiovascular diseases]] |
[[Category:Cardiovascular diseases]] |
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{{Med-sign-stub}} |
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Latest revision as of 12:14, 21 January 2024
 | This article needs more reliable medical references for verification or relies too heavily on primary sources. (November 2021) |  |
Pulsus bigeminus is a cardiovascular phenomenon characterized by groups of two heartbeats close together followed by a longer pause. The second pulse is weaker than the first. Look for a pattern of what appears to be a relatively normal QRS complexes, each followed by a smaller, abnormal one. The smaller beat is palpated as either a missing or an extra beat, and on EKG resembles a PVC.[1] These PVCs appearing every other beat are also called extrasystoles.
This phenomenon can be a sign of hypertrophic obstructive cardiomyopathy or of many other types of heart disease (see list below). Other causes include digitalis toxicity, induction of anesthesia,[2] placement of surgical instrumentation into the thorax or as a benign, temporary phenomenon.
In Pulsus Bigeminus not all of the conducted electrical activity will elicit sufficient ventricular contraction to produce a palpable pulse. This is important for two reasons. One, an ECG may give a ventricular contraction rate that does not correspond to the palpated pulse rate. Secondly, because not all beats are being conducted, patients may present with symptoms of low output heart failure, e.g. Dizziness, shortness of breath or hypotension, even with a normal ECG.
Cause[edit]
Causes Include:
- Electrolyte imbalance e.g. Hypo or hyperkalemia
- Hypothyroidism
- Betablocker therapy
- Digoxin
- Myocardial Infarction
- Destruction or degeneration of the cardiac conduction system or heart muscle cells
- Infection
A doctor can discriminate pulsus bigeminus from pulsus alternans by auscultating the heart.
Management[edit]
Management includes looking for and removing underlying cause, including medicines (such as a Calcium Channel blocker) and inotropic therapy to return cardiac output back to normal. If highly symptomatic over a longer period ablation therapy may be the only viable option.
See also[edit]
References[edit]
- ^ Anand, Nidhi; Manish Anand; Alok Vardhan Mathur; Madhukar Maletha; SK Ghildyal (2010-02-03). "Intra-operative ventricular bigeminy: Can retractor be a cause". Journal of Anaesthesiology Clinical Pharmacology. 26 (4): 569–570. doi:10.4103/0970-9185.74626. PMC 3087243. PMID 21547204. Retrieved 2012-05-16.
- ^ ROLLASON, WN; D. J. HALL (March 1973). "Dysrhythmias during inhalational anaesthesia for oral surgery". Anaesthesia. 28 (2): 139–145. doi:10.1111/j.1365-2044.1973.tb00305.x. PMID 4144496.