Edit concept Create issue ticket

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]
  • A 65-year old male originally presented with repetitive ventricular bigeminal sequences demonstrating progressive prolongation of successive coupling intervals suggesting Wenckeback-type exit block.[ncbi.nlm.nih.gov]
  • A 31-year-old primiparous, healthy woman presented for emergency caesarean section. Following the siting of a spinal anaesthetic, seconds after starting a phenylephrine infusion, she developed ventricular bigeminy.[ncbi.nlm.nih.gov]
  • The patient was a 23-year-old man who presented to an emergency department following an alleged cobra bite. There was transient episode of nausea, vomiting, hypotension and tachycardia.[ncbi.nlm.nih.gov]
  • This presentation reflects a case of atypical concealed bigeminy, where some interectopic intervals contain even numbers of sinus beats. Exceptions to the rule of concealed bigeminy only occur during slowing of the sinus node.[ncbi.nlm.nih.gov]
Orthopnea
  • His symptoms of dyspnea and orthopnea resolved. Postoperative electrocardiogram readings revealed a progressive decrease in the frequency of arrhythmias, with the patient predominantly in normal sinus rhythm [ [Figure 3] b].[ijo.in]
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
  • 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]
  • However: In patients with ischaemic heart disease, these may be significant and caused by the ischaemia. Beware the multiple premature ventricular ectopics in MI.[resus.com.au]
  • Pre-existing heart disease is a known cause of peri-operative cardiac arrhythmias. Our patient had no history suggestive of any heart disease and had a normal pre-operative ECG.[joacp.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]
  • A few weeks ago I started having irreg., skipped beats all the time.[medhelp.org]
  • These extra beats disrupt your regular heart rhythm, sometimes causing you to feel a fluttering or a skipped beat in your chest. Premature ventricular contractions are common — they occur in many people.[mayoclinic.org]
  • VPBs may be experienced as missed or skipped beats; the VPB itself is not sensed but rather the following augmented sinus beat.[merckmanuals.com]

Workup

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]
  • 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 Vent.[ekg.academy]
  • A premature ventricular complex is recognized on the ECG as an abnormal and wide QRS complex occurring earlier than expected in the cardiac cycle.[ecgwaves.com]
  • Conduction through the ventricle is not rapid via the Bundle of His, and is therefore slowed down giving a wide QRS complex. Atrial Bigeminy Atrial Bigeminy is a harmless, benign rhythm.[ecgclass.co.uk]
Prominent U Wave
  • U waves along with ST segment and T wave depression is a significant sign of hypokalemia. [12] In a hypokalemic patient, hyperventilation leads to respiratory alkalosis precipitating arrhythmias by further reducing potassium. [4] Hypokalaemia treatment[jemds.com]

Treatment

  • 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]
  • We recommend that if there is associated LV dysfunction and a causal link to frequent PVCs then suppression with radiofrequency ablation is a safe and effective treatment strategy.[ncbi.nlm.nih.gov]
  • Thus surgical intervention is an effective method for the treatment of patients with symptomatic, drug-resistant ventricular allorhythmias.[ncbi.nlm.nih.gov]
  • She was administered to the Neurology Department for scheduled initiation of apomorphine treatment.[e-jmd.org]
  • Consider the causes, manifestations and treatment methods of the disease.[vascular.vsebolezni.com]

Prognosis

  • 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]
  • However, structural heart disease and poor left ventricular function are the key factors in determining the need for treatment and assessing the prognosis. [7] , [8] In our case, we have taken extreme caution in administering pharmacological agents for[karnatakaanaesthj.org]
  • A few premature ventricular contractions on a daily basis in otherwise healthy individuals is considered benign and has no effect on cardiovascular prognosis.[ecgwaves.com]

Etiology

  • 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]
  • 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]
  • 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]
  • Practically all categories in the chapter could be designated 'not otherwise specified', 'unknown etiology' or 'transient'.[icd10data.com]

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

  • 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]
  • 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]
  • 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]
  • The patient's critical condition prevented our determining the effect of altering parasympathetic activity, but our observations led us to believe that the relationship between the occurrence of hiccups and the disappearance of ventricular extrasystoles[ncbi.nlm.nih.gov]
  • DDDR pacing following implantation of an atrial lead prevented further ventricular tachyarrhythmias.[ncbi.nlm.nih.gov]
  • The transaortic approach can be considered as a new and important surgical option for endocardial mapping and cryocoagulation which prevents the damaging effects of a left ventriculotomy.[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]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!