Presentation
In this report, electrophysiologic studies on five patients with fixed coupled atrial bigeminy, identical impulse intervals arriving at the His bundle and alternating bundle branch aberrancy are presented. [ncbi.nlm.nih.gov]
Four had sinus bradycardia, six presented with blocked atrial bigeminism, three showed 2:1, and five had a complete atrio-ventricular (AV) block. [scite.ai]
Strengths with possible “problems expected at birth with advice on how to manage them are presented. Logical outline of management. [books.google.com]
Entire Body System
- Asymptomatic
Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. [books.google.com]
The frequency of asymptomatic disturbances of cardiac rhythm and conduction in middle-aged men. Am J Cardiol 1969;24:629–50 PubMed CrossRef Google Scholar 7. Engstrom G, Hedblad B, Juul-Moller S, et al. [link.springer.com]
(asymptomatic during this event) If you look closely at the T waves in V1 and compare the the complexes on the left and during the bradycardia, then you see that the T waves are "pointee". [learningecg.blogspot.com]
During follow-up, the patient remained asymptomatic, with stable sinus rhythm and no antiarrhythmic treatment. No recurrence was documented on Holter ECG at 3, 6, or 12 months.. Corresponding author: [email protected] [revespcardiol.org]
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/Main_Page Treatment Asymptomatic atrial bigeminy is treated with digitalis or quinidine. Ventricular bigeminy is treated with suppressive drugs. [wikidoc.org]
- Congestive Heart Failure
[…] block, left and right ventricular ejection fraction (19y-12%/14%); congestive heart failure; deceased (sudden death) TTN TTN 2 2 Johan den Dunnen 00080869 - Trujillano et al., submitted unaffected parents - - - - - 0 - - myopathy, early-onset, with fatal [databases.lovd.nl]
This can manifest in congestive heart failure, or a form of what is called hydrops. So, the important questions here are whether the baby has a structurally normal heart and also if the ventricles, the pumping chambers, are working adequately. [medhelp.org]
Sinus Rhythm With Atrial Bigeminy This ECG is from an 88-year-old man with congestive heart failure. No other clinical information is known. [ecgguru.com]
Sinus tachycardia Common Rule out hypoxemia and hypovolemia; provide adequate analgesia; evaluate for congestive heart failure. [aafp.org]
In these patients rhythm control is often tried first if they are younger, symptomatic or have congestive heart failure. [thoracickey.com]
- Surgical Procedure
In rare cases of bigeminy that require more aggressive treatment, a doctor may recommend a surgical procedure called catheter ablation. This process involves scarring heart tissue in a way that blocks abnormal electrical signals. [medicalnewstoday.com]
Having a pacemaker fitted is usually a minor surgical procedure carried out under a local anaesthetic (the area being operated on is numbed and you're conscious during the procedure). [nhs.uk]
Automatic SVT, including incessant SVT, can appear at any age sometimes after flu or surgical procedures. [thoracickey.com]
In a fetus with atrioventricular block and congenital heart defects who survives into the neonatal period, the response to hemodynamic compromise from cardiac or noncardiac surgical procedures and to stress is abnormal and often leads to abrupt, profound [ncbi.nlm.nih.gov]
Respiratoric
- Dyspnea
AFIB with a rapid ventricular response may produce s/s such as lightheadedness, palpitations, dyspnea, CP, and hypotension. [ekginterpretation.tripod.com]
[…] chest pain of anginal characteristics, and simultaneously also shows symptoms typical of an anaphylactic reaction: hypotension in the context of contact with a known allergen, skin manifestations (rash, urticaria, angioedema), respiratory alterations (dyspnea [medintensiva.org]
- Cough
Coughing Not technically a manoeuvre but can be used to stimulate the vagal nerve. Encourage the patent to cough hard. Atrial Fibrillation The single most commonly encountered arrhythmia increases the annual risk of stroke by around 4–5 %. [thoracickey.com]
Gastrointestinal
- Vomiting
The most common side effects of anti-arrhythmics are: beta-blockers – tiredness, cold hands and feet, low blood pressure, nightmares and impotence flecainide – nausea, vomiting and heart rhythm disorders amiodarone – sensitivity to sunlight (high-protection [nhs.uk]
Short-term use preferred, fetal growth restriction Sotalol 160–480 mg daily in two equal daily doses or every 8 h PO NA Bradycardia, first-degree atrioventricular block, P and QRS widening, QT prolongation Nausea and/or vomiting, dizziness, fatigue, bundle [ncbi.nlm.nih.gov]
[…] anaphylactic reaction: hypotension in the context of contact with a known allergen, skin manifestations (rash, urticaria, angioedema), respiratory alterations (dyspnea, wheezing, dysphonia, stridor) and/or digestive disorders (abdominal pain, nausea, vomiting [medintensiva.org]
Cardiovascular
- Tachycardia
Entrainment from right ventricular apex was performed during sustained tachycardia at a CL 20 ms shorter than that of the tachycardia. [ncbi.nlm.nih.gov]
[…] rhythm His bundle tachycardia Idiojunctional tachycardia Idioventricular rhythm Inappropriate sinus tachycardia Inappropriate sinus tachycardia (rapid heart beat) Incessant atrial tachycardia Incisional tachycardia Labile pulse Left atrial incisional [icd9data.com]
[…] like atrial tachycardia no P wave and tight QRS wave superventricular tachycardia describes atrial or nodal tachycardia etopics fired from same origin >5: high risk sinus arrest followed by wide QRS wave and inverted T wave; no P wave unifocal ventricular [quizlet.com]
Ventricular Flutter Ventricular Fibrillation Ventricular Tachycardia Ventricular Tachycardia Monomorphic Ventricular Tachycardia Polymorphic Ventricular Tachy. [ekg.academy]
Its name is made of… … Wikipedia Tachycardia — A rapid heart rate, usually defined as greater than 100 beats per minute. The tachycardias include sinus tachycardia, paroxysmal atrial tachycardia (PAT), and ventricular tachycardia. [translate.academic.ru]
- Heart Disease
We report the case of a 22-year-old woman with no prior cardiac disease presenting with exercise intolerance since several months. No apparent heart disease other than a spontaneous conducted atrial bigeminy with a short coupling interval was found. [ncbi.nlm.nih.gov]
[…] for Disease, Diagnosis I49.1 ICD Code an Classification Atrial premature depolarization Chapter, Outline, Main Categories, Parent Concepts or Top Concepts: I00-I99 Diseases of the circulatory system (I00-I99)|I30-I52 Other forms of heart disease (I30 [averbis.com]
Arrhythmias documented by 24-hour continuous ambulatory electrocardiographic monitoring in young women without apparent heart disease. Am Heart J 1981;101:753–9 PubMed CrossRef Google Scholar 3. Folarin VA, Fitzsimmons PJ, Kruyer WB. [link.springer.com]
Class II drugs (beta-blockers) are the drugs of choice in patients who are symptomatic but do not have structural heart disease. [emedicine.medscape.com]
- Ventricular Bigeminy
«HealthTechZone, May 12» How to recognise and manage idiopathic ventricular tachycardia RVOT non-sustained monomorphic ventricular tachycardia (on the left side) and LVOT ventricular bigeminy (on the right side). Figure 2. [educalingo.com]
[…] disorder of rhythm. 10 Ventricular Quadrigeminy as a Manifestation of Concealed Bigeminy N. [semanticscholar.org]
Casopis Lekaru Ceskych 102: 1252-1253, 1963 Mechanisms of concealed ventricular bigeminy: the concept of concealed conduction in the reentrant pathway. [eurekamag.com]
The patient is in Ventricular Bigeminy. Bigeminy comes for the latin for ‘twins’. On an ECG strip, it presents as a sinus beat with a premature ventricular complex immediately following. [resus.com.au]
Other forms of abnormal beats include PAC, escape beats and parasystole. [1] Classification Atrial bigeminy Junctional bigeminy Ventricular bigeminy Concealed bigeminy Escape capture bigeminy [2] Pathophysiology Several mechanisms can be involved in the [wikidoc.org]
- Palpitations
People may experience bigeminy as heart palpitations. However, not all sensations of palpitations are due to arrhythmia. [medicalnewstoday.com]
While highly unlikely to be afib, your palpitations could still be due to PACs or PVCs. [theskepticalcardiologist.com]
58 year old male Mr.Kannan, who came to hypertension OP for routine checkup No H/o chest pain, palpitation or syncope Known smoker for past 20 years – 10 cigarettes per day Not an acoholic Not a K/C/o DM, CAD, COPD, BA, PTB, Epilepsy, Thyr oid [slideshare.net]
Patient may c\o palpitations (if frequent) or may be unaware of the occurrence. Interventions Usually none, if infrequent. [ekginterpretation.tripod.com]
- Heart Failure
Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. [books.google.com]
[…] block, left and right ventricular ejection fraction (19y-12%/14%); congestive heart failure; deceased (sudden death) TTN TTN 2 2 Johan den Dunnen 00080869 - Trujillano et al., submitted unaffected parents - - - - - 0 - - myopathy, early-onset, with fatal [databases.lovd.nl]
They'll consider your age and whether you have a history of any of the following: stroke or blood clots heart valve problems heart failure high blood pressure (hypertension) diabetes heart disease You may be given medication according to your risk of [nhs.uk]
This can manifest in congestive heart failure, or a form of what is called hydrops. So, the important questions here are whether the baby has a structurally normal heart and also if the ventricles, the pumping chambers, are working adequately. [medhelp.org]
Sinus Rhythm With Atrial Bigeminy This ECG is from an 88-year-old man with congestive heart failure. No other clinical information is known. [ecgguru.com]
Fetus
- Hydrops Fetalis
Impact of hydrops fetalis on survival An important distinction in terms of the fetal prognosis is whether hydrops fetalis is present. This condition, in the presence of atrioventricular block, is almost uniformly fatal. [ncbi.nlm.nih.gov]
Workup
We all weill have some of this happen from time to time throughout our lives, but this is excessive and you deserve a better, more thoroug workup by a subspecialist who may well be able to resolve this for you or at least make it much more tolerable. [doctorslounge.com]
PR Interval
- Prolonged PR Interval
The rarer and more ominous Mobitz II second degree AV block (which frequently progresses to complete heart block) features normal or slightly prolonged PR intervals until a ventricular complex is dropped. 1 Close inspection of the P-QRS relationship on [journals.lww.com]
PJRT and atypical AVNRT are characterized by a normal or slightly prolonged PR interval with negative P waves in the inferior leads and positive P waves in aVR and aVL. [thoracickey.com]
Blocks
- 2:1 Atrioventricular Block
Background Blocked atrial bigeminy (BAB) and second-degree atrioventricular block with 2:1 conduction block (2:1 AVB) both present as ventricular bradycardia and can be difficult to distinguish by echocardiography. [scholars.northwestern.edu]
Magnetophysiologic and echocardiographic comparison of blocked atrial bigeminy and 2:1 atrioventricular block in the fetus. During the ventricular bigeminy the heart rate almost doubled to around 90-100/min. [freethesaurus.com]
Rhythm
- Premature Atrial Contractions
premature complexes|Multiple atrial premature complexes (disorder)|PAC - Premature atrial contraction|Premature atrial contraction|Premature atrial contraction (disorder)|Run of atrial premature complexes|Run of atrial premature complexes (disorder)| [averbis.com]
Premature Atrial Contraction (PAC) [Online image]. Retrieved July 19, 2016, from http://jantungoke.com/2012/12/premature-atrial-contraction-pac.html MIT-BIH Arrhythmia Database. (1980). [sites.google.com]
A fetus with premature atrial contractions had a prolonged second-stage heart rate of 80 beats/min. [ncbi.nlm.nih.gov]
Premature atrial contraction on ECG A premature atrial contraction occurs when an ectopic focus in the atria discharges before the next sinus impulse. [ecgwaves.com]
[…] abnormal or hidden PR Interval: Less then 200ms QRS Interval: Less then 120ms Premature Atrial Contraction Paired Heart Rate: None P Wave: Premature and abnormal or hidden PR Interval: Less then 200ms QRS Interval: Less then 120ms Premature Atrial Contraction [heartrhythmguide.com]
- Ventricular Bigeminy
«HealthTechZone, May 12» How to recognise and manage idiopathic ventricular tachycardia RVOT non-sustained monomorphic ventricular tachycardia (on the left side) and LVOT ventricular bigeminy (on the right side). Figure 2. [educalingo.com]
[…] disorder of rhythm. 10 Ventricular Quadrigeminy as a Manifestation of Concealed Bigeminy N. [semanticscholar.org]
Casopis Lekaru Ceskych 102: 1252-1253, 1963 Mechanisms of concealed ventricular bigeminy: the concept of concealed conduction in the reentrant pathway. [eurekamag.com]
The patient is in Ventricular Bigeminy. Bigeminy comes for the latin for ‘twins’. On an ECG strip, it presents as a sinus beat with a premature ventricular complex immediately following. [resus.com.au]
Other forms of abnormal beats include PAC, escape beats and parasystole. [1] Classification Atrial bigeminy Junctional bigeminy Ventricular bigeminy Concealed bigeminy Escape capture bigeminy [2] Pathophysiology Several mechanisms can be involved in the [wikidoc.org]
- Sinus Arrhythmia
DIFFERENTIAL DIAGNOSIS Sinus arrhythmia 3 : 2 atrial block 2 : 1 atrial flutter 13. SIGNIFICANCE Usually benign Can be a forerunner of atrial tachycardias and atrial fibrillations 14. THANK YOU [slideshare.net]
Caliper Time Interval: ___ seconds Sinus Normal Sinus Rhythm Sinus Arrhythmia Sinus Bradycardia Sinus Tachycardia Sinus Arrest Atrial Atrial Bigeminy Atrial Fibrillation Atrial Flutter Atrial Tachycardia Multifocal Atrial Tachycardia Atrial Trigeminy [ekg.academy]
In several case reports, ECG changes during the vasovagal reflex among patients with needle phobia have included sinus arrhythmia, premature atrial contractions, premature junctional contractions, unifocal and multifocal premature ventricular contractions [freethesaurus.com]
[…] tachycardia Inappropriate sinus tachycardia (rapid heart beat) Incessant atrial tachycardia Incisional tachycardia Labile pulse Left atrial incisional tachycardia Left atrial rhythm Marked sinus arrhythmia Moderate hypokinesis of cardiac wall Multifocal [icd9data.com]
Sinus arrhythmia has a periodicity to it, yet the P waves do not vary. [journals.lww.com]
P Wave
- Inverted P Wave
MCTh Medical Student Well to me it looks like invertered P waves in leads II and III and aVF. could mean an ectopic atrial rhythm or AV junction problem. abnormal impulse propagation through atria will affect P-wave. [app.figure1.com]
PACS arising close to the AV node (“low atrial” ectopics) activate the atria retrogradely, producing an inverted P wave with a relatively short PR interval ≥ 120 ms (PR interval < 120 ms is classified as a PJC). [lifeinthefastlane.com]
[…] interval P wave morphology The P wave typically has a different morphology and axis to the sinus P waves PACs arising close to the AV node (“low atrial” ectopics) cause retrograde activation of the atria, producing an inverted P wave with a relatively [litfl.com]
Treatment
Acute management Treatment steps for VPC include looking for and correcting the reversible causes (eg, hypoxia, hypokalemia, hypomagnesemia). Long-term treatment The long-term treatment of VPCs is highly controversial. [emedicine.medscape.com]
Current Medical Diagnosis and Treatment 2014 (53 ed.). New York: McGraw-Hill Medical. ISBN 9780071806336. [en.wikipedia.org]
Prognosis
Since the prognosis and clinical management of these rhythms are different, an accurate diagnosis is essential. OBJECTIVE: To identify magnetic and mechanical heart rate and rhythm parameters that could reliably distinguish BAB from 2:1 AVB. [ncbi.nlm.nih.gov]
Since the prognosis and clinical management of these rhythms are different, an accurate diagnosis is essential. Objective To identify magnetic and mechanical heart rate and rhythm parameters that could reliably distinguish BAB from 2:1 AVB. [scholars.northwestern.edu]
Prognosis Although some studies have found the prognosis to be better in type I KS, in both types the prognosis depends on the magnitude of the initial allergic reaction, the patient sensitivity, comorbidity, location of the antigen–antibody reaction, [medintensiva.org]
Etiology
Such is the case in the Figure, in which the key clue to the etiology of this bigeminal rhythm lies with inspection of the T wave of beat No. 1 on the tracing. [ahcmedia.com]
Distinguishing between early-occurring wide beats that are ventricular in etiology (ie, PVCs ) vs PACs that are wide because of aberrant conduction is at times a challenging task! [ecg-interpretation.blogspot.com]
This then allows for re-entrant circuits and sets up the ventricle for another PVC after the next sinus beat.[2] The constant interval between the sinus beat and PVC suggests a reentrant etiology rather than spontaneous automaticity of the ventricle.[ [en.wikipedia.org]
Epidemiology
Relationship of premature systoles to coronary heart disease and sudden death in the Tecumseh epidemiologic study. Ann Intern Med 1969;70:1159–66 PubMed Google Scholar 6. Hinkle LE, Carver ST, Stevens M. [link.springer.com]
Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2(1):43–53. 2. Sacco RL, Ellenberg JH, Mohr JP, et al. [dovepress.com]
Conclusions KS is underdiagnosed, and further studies are needed to better understand its epidemiology, clinical characteristics and diagnosis, as well as to better define the opportune preventive and therapeutic measures. [medintensiva.org]
Pathophysiology
Other forms of abnormal beats include PAC, escape beats and parasystole. [1] Classification Atrial bigeminy Junctional bigeminy Ventricular bigeminy Concealed bigeminy Escape capture bigeminy [2] Pathophysiology Several mechanisms can be involved in the [wikidoc.org]
This review investigates the correlation between MVP and SCD, the understanding of the pathophysiology, the strategies for detecting those at risk and treatment options... [read.qxmd.com]
In fact, the most commonly encountered mutation in this setting is in HERG genes, coding for potassium channel IKr. 3) Pathophysiology of atrio-ventricular block-induced torsades de pointes Although a slow ventricular rate may be a major factor for inducing [escardio.org]
Prevention
In large trials, the medicines have been shown to be as effective or more effective than warfarin at preventing strokes and deaths. They also have a similar or lower rate of major bleeding. [nhs.uk]
Prevention of recurrent cerebral ischemic events in patients with patent foramen ovale and cryptogenic strokes or transient ischemic attacks. Can J Cardiol. 1999;15(1):57–64. 29. [dovepress.com]
Still, some lifestyle changes can prevent your PVCs from getting worse or more frequent. Since anxiety can cause your heartbeat to speed up or be abnormal, find a way to reduce your stress. [webmd.com]
In conclusion, thorough history, clinical examination, and judicious use of antiarrhythmic agents recommended during pregnancy can prevent an asymptomatic ventricular ectopy transforming into a fatal arrhythmia in managing a case of ventricular bigeminy [karnatakaanaesthj.org]
A drug which prevents stimulation of the beta adrenergic receptors, thus decreasing the heart’s activity What is a commonly used beta blocker? Propranolol (Generic name) Inderal (Trade name) What does ‘generic‘ name mean? Technical name of drug. [unm.edu]