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Ventricular Bigeminy


Presentation

  • The distributional pattern of sinus conducted beats in the present case conforms to a formula defining this unusual disorder of rhythm, while the appearance of manifest ectopic beats follows the rule of bigeminy.[ncbi.nlm.nih.gov]
Respiratory Abnormalities
  • He did not have any signs or symptoms of cardio-respiratory abnormality and his systemic and haematological examination were normal.[jnaccjournal.org]
Cheyne-Stokes Respiration
  • Provocation of ventricular ectopy by cheyne-stokes respiration in patients with heart failure. Sleep 2004;27:1337-43. 4. Oppenheimer S. Cerebrogenic cardiac arrhythmias: Cortical lateralization and clinical significance. Clin Auton Res 2006;16:6-11.[neurologyindia.com]
Nausea
  • There was transient episode of nausea, vomiting, hypotension and tachycardia. The ECG showed infrequent ventricular ectopics that progressed to ventricular bigeminy and persisted even after the vital signs normalized.[ncbi.nlm.nih.gov]
  • Its effect is waning after about an hour. 3, 4 The most common side effects are cutaneous nodules at the injections sites, nausea, headache, diarrhoea, weakness and orthostatic hypotension. 5 Hallucinations, chest pain and visual disturbances may occur[e-jmd.org]
Vomiting
  • There was transient episode of nausea, vomiting, hypotension and tachycardia. The ECG showed infrequent ventricular ectopics that progressed to ventricular bigeminy and persisted even after the vital signs normalized.[ncbi.nlm.nih.gov]
Hiccup
  • Although hiccups may increase vagal discharges by modulating changes in respiratory stretch receptors or atrial filling, it is more likely that a hiccup-induced Valsalva maneuver was responsible for abolishing ventricular bigeminy in our patient.[ncbi.nlm.nih.gov]
Heart Disease
  • Cardiac causes like acute and chronic ischemic heart disease, cardiomyopathy, valvular heart disease, mitral valve prolapse can cause ventricular ectopic.[neurologyindia.com]
  • Patients with no ischaemic heart disease or cardiomyopathy have an excellent prognosis. Ventricular extrasystoles after myocardial infarction are associated with increased mortality. They may be the presenting feature of viral myocarditis.[gpnotebook.co.uk]
  • Incessant monomorphic ventricular bigeminy was studied in a young patient with no organic heart disease. The arrhythmia could not be controlled by drug therapy.[ncbi.nlm.nih.gov]
  • It is important to determine whether underlying structural heart disease is present and left ventricular function is impaired.[karnatakaanaesthj.org]
Skipped Beats
  • Usually benign: Premature or "skipped" beats frome the bottom chambers of the heart are common; they sometimes occur in fixed patterns. When every other beat is a premature beat, it's called ventricular bigeminy.[healthtap.com]
  • VPBs may be experienced as missed or skipped beats; the VPB itself is not sensed but rather the following augmented sinus beat.[merckmanuals.com]
  • Many patients describe them as skipped beats, because when they check their pulse, they don’t feel anything for a moment. However, your heart is not actually skipping or missing a beat.[equimedcorp.com]
  • A few weeks ago I started having irreg., skipped beats all the time.[medhelp.org]
Irregular Heart Rhythm
  • Ventricular Arrhythmias Premature ventricular contractions (PVCs) are the most common cause of irregular heart rhythms.[my.clevelandclinic.org]
  • A similar observation between cough and irregular heart rhythm was reported by Odeh and Oliven 9 ; however, they identified atrial premature complexes, and not PVCs, as factors inducing chronic cough.[erj.ersjournals.com]
Palpitations with Skipped Beats
  • When a PVC occurs as a single premature beat, patients may describe the feeling as a "palpitation" or "skipped beat." The beat following the PVC can be strong enough to cause pain or discomfort in the chest.[my.clevelandclinic.org]
Tinnitus
  • Available from: Sir, A 12-year-old, 39 kg American Society of Anaesthesiologists (ASA) grade I, male patient presented with proptosis of right eye ball since 6 months and tinnitus in right ear since 2 months.[jnaccjournal.org]
Redness of Eye
  • However, he again developed ventricular bigeminy, chest pain and redness of eyes after the injection of amoxicillin clavunate, but the severity was more intense so it was treated with β blockers and amiodarone.[degruyter.com]
Withdrawn
  • Catheter tip was withdrawn immediately. After sometime left VA catheterization was again attempted, while catheter was in-situ in left VA, ventricular bigeminy recurred which disappeared with the withdrawal of catheter [Figure 1] .[neurologyindia.com]
Cesarean Section
  • We present the management of a case of 21-year-old female patient presenting with ventricular bigeminy posted for elective lower segment cesarean section in our institution.[karnatakaanaesthj.org]

Workup

  • […] combined spinal–epidural anaesthesia, where giving a small dose of intrathecal local anaesthetic followed by epidural drugs is an effective management strategy. [5] The aim of submitting this case report was to emphasise the fact that after adequate workup[ijaweb.org]
Mediastinal Shift
  • Her CT scan head showed multiple contusions, ECG revealed normal sinus rhythm, chest X-ray showed bowel loops shadow in left hemithorax with mediastinal shift to the right and findings confirmed on CT-scan Chest.[joacp.org]
Wide QRS Complex
  • The signal that originated in the ventricle can be distinguished from a normal signal by its wide QRS complex and lack of a P wave. An isolated incidence of ventricular bigeminy is likely harmless.[wisegeek.com]
  • Depending on the etiology, onset of ventricular tachycardia can be paroxysmal (sudden) or nonparoxysmal, its wide QRS complexes can be uniform or polymorphic, and the ventricular beating may be independent of the atrial beating (AV dissociation).[ncbi.nlm.nih.gov]
  • Look for a wide QRS complex, equal or greater than 0.12 sec. The QRS complex shape can be bizarre. The P wave will be absent. Premature Ventricular Complex - Bigeminy Premature Ventricular Complex - Trigeminy Premature Vent.[ekg.academy]
  • Diagnosis of ventricular premature beats is by ECG showing a wide QRS complex without a preceding P wave, typically followed by a fully compensatory pause.[merckmanuals.com]

Treatment

  • She was administered to the Neurology Department for scheduled initiation of apomorphine treatment.[e-jmd.org]
  • Thus surgical intervention is an effective method for the treatment of patients with symptomatic, drug-resistant ventricular allorhythmias.[ncbi.nlm.nih.gov]
  • Consider the causes, manifestations and treatment methods of the disease.[vascular.vsebolezni.com]

Prognosis

  • Patients with no ischaemic heart disease or cardiomyopathy have an excellent prognosis. Ventricular extrasystoles after myocardial infarction are associated with increased mortality. They may be the presenting feature of viral myocarditis.[gpnotebook.co.uk]
  • The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis. Postgrad. Med. J. 2003;79;490-504. doi:10.1136/pmj.79.935.490 Wang, K., et al. 1976.[thejarvik7.wordpress.com]
  • Presence of heart disease should be sought and, if absent, indicates good prognosis in patients with PVCs.[escardio.org]
  • The importance of VPBs for prognosis is controversial. A study by Abdalla et. al Kennedy HL, Whitlock JA, Sprague MK, Kennedy LJ, Buckingham TA, and Goldberg RJ.[en.ecgpedia.org]

Etiology

  • The constant interval between the sinus beat and PVC suggests a reentrant etiology rather than spontaneous automaticity of the ventricle.[ecg-educator.blogspot.com]
  • In addition, the arrhythmia canto be caused by the body's reaction to disease processes: Hyperthyroidism; Tumors of various etiology; Osteochondrosis of the cervical spine; Allergies; Pathology of the stomach, diaphragmatic hernia, tuberculosis; Chronic[vascular.vsebolezni.com]
  • Depending on the etiology, onset of ventricular tachycardia can be paroxysmal (sudden) or nonparoxysmal, its wide QRS complexes can be uniform or polymorphic, and the ventricular beating may be independent of the atrial beating (AV dissociation).[ncbi.nlm.nih.gov]
  • Left ventricular ejection fraction was 20% and the etiology of the cardiomyopathy was presumed to be secondary to viral infection. He developed persistent atrial fibrillation (AF).[innovationsincrm.com]
  • They are organised into groups, and further divided into clinical, etiological or histopathological sub-types.[orpha.net]

Epidemiology

  • Epidemiology [ 1 ] Both atrial and ventricular extrasystoles are common at all ages. Atrial extrasystoles These are common in healthy people with normal hearts. There are often seen on 24-hour Holter monitoring in over 60% of healthy adults.[patient.info]
  • Some epidemiological data exist with an association between PVCs activity with caffeine intake, but experimental human studies have not produced consistent results to establish this link.[escardio.org]
  • […] hypokalemia, hypomagnesemia, or hypercalcemia) Medications (eg, digoxin, tricyclic antidepressants, aminophylline, amitriptyline, pseudoephedrine, fluoxetine) Other drugs (eg, cocaine, amphetamines, caffeine, alcohol) Anesthetics Surgery Infection Stress Epidemiology[emedicine.medscape.com]
Sex distribution
Age distribution

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[wikidoc.org]
  • Very few studies have evaluated the pathophysiology of VPBs in humans.[consultant360.com]
  • Keywords Ablation cardiology coronary artery disease electrocardiogram (ECG) electrophysiology heart heart rate pathophysiology physiology Editors and affiliations M. Ali Oto 1 1.[link.springer.com]
  • 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]
  • Very few studies have evaluated the pathophysiology of VPCs in human subjects.[emedicine.medscape.com]

Prevention

  • In addition to prevention of rupture of the diverticulum and thrombus formation, treatment of combined ventricular tachycardia is thought to be an indication for resection of the diverticulum.[ncbi.nlm.nih.gov]
  • 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]

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