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. Other causes include digitalis toxicity or it simply being a benign, temporary phenomenon. In Pulsus bigeminus an ECG may give a ventricular contraction rate that does not correspond to the palpated pulse rate. This is because not all of the conducted electrical activity will elicit sufficient ventricular contraction to produce a palpable pulse. Therefore patients may present with symptoms of low output heart failure, e.g. Dizziness, shortness of breath or hypotension, even with a normal ECG. 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.

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

See also