Pulsus bigeminus

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. It is caused by premature contractions (see Premature atrial contraction or ventricular), usually of the 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. It is important to look for peripheral pulse deficit since the ECG may give a heart rate of 60 beats per minute, in fact, the palpated pulse is only 30 because the 2 nd beat is not producing a sufficient cardiac stroke volume hence the cardiac output is low and the patients is symptomatic e.g. Dizziness, shortness of breath or hypotension. Treatment is to look for underlying cause and if possible treat this or stop the causing noxe, medication to treat is Atropin intravenous, itrop oral. Possible oral trial of Effortil. If highly symptomatic over a longer period ablation therapy is a viable option.

Causes Electrolyte imbalance e.g. Hypo or hyperkalemia Hypothyroidism Betablockertherapy Digoxin Myocardial ischemia Destruction or degeneration of the cardiac conduction system or heartmusclecells Infection

See also