Bigeminy is a medical term referring to the sensation of the heart skipping a beat, also described as heart fluttering or palpitations. Bigeminy occurs when the rhythm of the heart become irregular, causing blood to move through it in an abnormal manner. The condition is essentially a normal heartbeat followed by a premature one, with the most common symptom being feeling an irregular heartbeat.
Bigeminy can occur at any age, however, it is far more common in older adults. Most people will experience bigeminy at some point in their lives, but most of the time, it is not a cause for concern.
What does bigeminy mean?
The rhythm of the heart is dictated by electrical impulses. These are important to ensure the heart muscles contract steadily and efficiently enough to push the required amount of blood throughout the entirety of the human body. If the heart does not pump the necessary volume of blood, it can lead to various cardiac related symptoms.
In cases of bigeminy, each normal heartbeat is followed by a beat that arrives much quicker than normal. It consists of a series of long and short beats. The word bigeminy itself helps to describe the condition as each set of two beats are considered “twins,” hence the name “bi + Gemini” (Latin for “twins”).
Bigeminy is most often due to ectopic beats occurring so frequently that there is one after each sinus beat (the normal electrical activity within the heart). Ectopic beats start from an area outside the sinus node which is normally responsible for setting the heart’s rhythm via the spontaneous production of electrical impulses.
Ectopic rhythms may originate from many different parts of the heart and produce a premature heartbeat. Therefore, an ectopic beat may also be called a premature atrial contraction (PAC) if emerging from the heart’s upper chambers, a premature ventricular contraction (PVC) if emerging from the heart’s lower chambers, or extrasystole, a heartbeat outside the normal rhythm.
The ventricles of the heart (the lower chambers) tend to be responsible for pumping the most amount of blood owing to their increased size and muscularity. An ectopic beat can cause the ventricle to beat prematurely before normal depolarization has occurred. This is often represented on ECG (electrocardiogram) as wider and taller QRS complexes, which represent the activity of the ventricular muscles.
Experiencing a “skipped beat” during a premature contraction may feel different from a normal heartbeat because, at this point, there is little to no blood being pumped out of the heart. This may feel as if the heart is beating faster than normal.
What are the causes and symptoms of bigeminy?
Bigeminy can occur in healthy individuals and at any age but does have a predilection for older people and those suffering from some sort of cardiac disorder.
Major bigeminy causes involve some alteration in the function of the heart, however, experts may not always be able to say what causes each case of bigeminy.
Causes of bigeminy may include abnormal quantities of minerals and/or electrolytes in the bloodstream. Your body needs these substances to ensure proper cellular processes all over the body perform efficiently, and this includes the operation of the heart and its rhythmic contraction. Low levels of minerals, such as magnesium, can lead to cardiac abnormalities and can be attributed to taking an excessive amount of diuretic medication.
Innate bodily hormones may also influence heart function as are often experienced during severe rushes of adrenaline that lead to rapid heart rates. Sustained adrenaline can eventually interrupt the rhythm of the heart and contributed to premature beat development.
Causes of bigeminy may also be a result of an underlying heart disorder, such as heart disease, or be due to outside stimulation from various sources such as nicotine, alcohol, caffeine, certain medication, and certain illicit drugs such as cocaine. Abnormal thyroid levels, inflammation, and reduced cardiac function that comes with age are also possible causes.
The signs and symptoms of atrial or ventricular bigeminy may appear similar to that of other kinds of arrhythmias, but in most cases, premature contractions go unnoticed. Possible symptoms of bigeminy include:
- Palpitations (noticeable rapid heartbeat)
- Fainting or passing out
- Shortness of breath
- Chest pain
How to diagnose bigeminy
When a heart condition is suspected, a full workup including medical history and physical exam will be done. This will provide any additional clues that can be used as evidence to proceed to further testing and includes taking pulse and blood pressure as well as checking for heart murmurs. Additional tests for diagnosis include:
This test is used to measure electrical signals that are produced when the heart contracts. A normal pattern can be cross-referenced to determine if the typical patterns of bigeminy are present.
Exercise stress test:
Used to monitor the heart’s activity during exercise with the aid of an ECG monitor. If premature contractions disappear during exercise, bigeminy may not be of much concern. However, if physical activity triggers premature heartbeats, it could be a sign of a more serious heart condition.
Requires the patient to wear a small, battery-powered medical device that measures heart activity, such as rate and rhythm over an extended period of time, usually over 24 hours. This will allow medical professionals to catch premature contractions when they occur.
Can be used to evaluate electrolyte levels as well as metabolic hormones such as thyroid hormone.
The use of sound waves that are able to produce real-time images of the heart muscles can reveal thickened muscle tissue of the left ventricle, blood flow through the heart with each beat, and other cardiac abnormalities.
Treating and preventing bigeminy
If a case of bigeminy leads to a loss of consciousness, CPR and electroshock therapy (defibrillation) is the recommended emergency treatment depending on the presentation. However, if there are no noticeable symptoms and no evidence of an underlying complication, you may not need treatment at all. The following bigeminy treatment recommendations may be given depending on the recommendations advised by your doctor.
Lifestyle changes: To help lower your risk of complications, eating a healthy diet that is low in saturated fats, cholesterol, and sodium goes a long way to helping the underlying conditions of arrhythmias. Exercise in a manner that doesn’t excessively strain the heart will also help reduce your risk. The avoidance of smoking cigarettes and drinking excessive amounts of alcohol are recommended. The only way for these lifestyle changes to have a significant impact on your heart health is to make them a part of your everyday life.
Medications: The use of prescribed heart medications can help reduce the workload of the heart and prevent arrhythmias. Certain medications can also be used to improve heart function depending on your particular circumstance. Cardiac medication may include:
- Beta-blockers: Reduce blood pressure and heart rate
- Calcium channel blockers: Relax and widen arteries and lowers blood pressure
- Aldosterone inhibitors: Help lower blood pressure and aid in the elimination of edema
- Diuretics: Helps to eliminated excess fluid, lowers blood pressure, and reduces the amount of work need to be done by the heart
- Blood thinners: Help prevent the development of blood clots
- Medications to control heart rate and rhythm
Surgery and other procedures: In more severe cases of ischemic cardiomyopathy that cannot be controlled by medication alone, more invasive methods of treatment will be required. These may include:
- Implantable pacemaker or defibrillator, or even both
- Angioplasty: To open narrowed arteries and place a stent to keep it open
- Catheter ablation: Used to destroy abnormal pacemaker cells causing arrhythmias
- Atherectomy: A minimally invasive procedure for removing plaque from blood vessels
Prognosis of bigeminy
Overall, in healthy individuals, the majority of bigeminy cases have symptoms that go away on their own, without the need for treatment. However, if you do feel faint or dizzy due to a perceived heart complication, seeing your doctor right away is highly recommended. For those who have been previously diagnosed with a heart condition, adhering to prescribed treatment plans will help reduce their risk of serious heart-related complications.