Bigeminy describes an irregular heart rhythm where the heart beats in a distinctive “every other beat” pattern. This condition involves extra heartbeats that interrupt the heart’s regular rhythm, creating sensations that vary among individuals.
What Bigeminy Is
A healthy heart maintains a steady, coordinated rhythm, with electrical signals guiding its chambers to contract in sequence. Bigeminy disrupts this pattern, characterized by a regular heartbeat immediately followed by an abnormal, premature beat. This repeating sequence of one normal beat and one extra beat gives the condition its name, derived from Latin words meaning “two twins.”
The location where the extra beat originates determines the specific type of bigeminy. Ventricular bigeminy, the most common form, occurs when the premature beat arises from the heart’s lower chambers (ventricles). When the extra beat originates from the upper chambers (atria), it is called atrial bigeminy. Less frequently, bigeminy can stem from the junctional area between the atria and ventricles.
Why Bigeminy Happens
Bigeminy arises from signaling issues within the heart’s electrical system. Common lifestyle triggers include emotional stress, anxiety, and excessive consumption of caffeine, alcohol, or nicotine. Certain medications, such as those for asthma or cold remedies, can also contribute to this irregular rhythm.
Underlying medical conditions play a role in bigeminy’s development. Imbalances in electrolytes like potassium, magnesium, and calcium can disrupt the heart’s electrical activity. Thyroid disorders and sleep apnea are also associated with bigeminy. Structural heart conditions, including coronary artery disease, heart attacks, high blood pressure, and cardiomyopathy, can trigger these extra beats.
How Bigeminy Feels
Many individuals with bigeminy experience no symptoms, often discovering the condition during a routine medical examination. For those who do, they often describe palpitations, which can feel like a skipped, racing, or pounding heart. Some report a fluttering sensation within their chest.
Other symptoms include lightheadedness or dizziness. They may also experience shortness of breath or mild chest discomfort. The intensity and frequency of these symptoms can vary.
How Bigeminy is Diagnosed and Managed
Diagnosis begins with a physical examination, including listening to the heart and checking pulse and blood pressure. A detailed medical history, including symptoms and lifestyle factors, is also taken. The primary diagnostic tool is an electrocardiogram (ECG or EKG), which records the heart’s electrical activity to identify the bigeminal pattern and pinpoint the origin of the extra beats.
Since bigeminy can be intermittent, a Holter monitor (a portable ECG) may be used to capture events over time. An event monitor can also be employed for longer-term tracking. An echocardiogram might be performed to assess the heart’s structure, while a stress test can evaluate how the heart responds to physical activity.
Management depends on symptoms and any underlying heart conditions. If bigeminy is asymptomatic and not associated with structural heart disease, treatment may not be necessary. Lifestyle modifications, such as reducing caffeine, alcohol, and nicotine intake, along with stress management and adequate sleep, are often recommended. Addressing underlying medical issues, like correcting electrolyte imbalances or treating thyroid disorders, is also important.
Medications like beta-blockers or calcium channel blockers may be prescribed for symptomatic cases. In rare instances, if bigeminy is severe, highly symptomatic, and unresponsive to other treatments, catheter ablation might be considered to target the source of the abnormal beats.
Living with Bigeminy
For many individuals, bigeminy is a benign condition. Regular medical follow-ups are important to monitor the heart rhythm and address any changes. Open communication with healthcare providers is encouraged to discuss symptoms and treatment options.
It is important to seek immediate medical attention if new or worsening symptoms develop. These include severe chest pain, prolonged dizziness, fainting spells, or significant shortness of breath. While bigeminy is often manageable, prompt evaluation of concerning symptoms ensures appropriate care.