What is bigeminia, causes, diagnosis and treatment

Bigeminia is not a separate nosology, for the most part it manifests itself as a concomitant symptom. There is another option for ventricular extrasystole – trigeminia, which will be discussed below.

The heart is a complex structure on which life depends on the quality of work. A person does not feel his heart when it is healthy – its contractions, blood flow, relaxation, etc. The medical name for heart rhythm disturbance is called arrhythmia.

There is also the concept of allorhythmia – the correct rhythmic alternation of extrasystoles and normal complexes, when there is 1 normal cycle, followed by extrasystole. If normal contractions and extrasystoles alternate:

  • through one (1: 1), then this is bigeminia;
  • after 2 normal complexes of contractions – ventricular trigeminia (1: 2);
  • 1 extrasystole through three normal contractions is called quadrigeminia (1: 3);
  • after four – pentaeminia.

Extrasystole as bigeminia is a type of arrhythmia in which extraordinary contractions of the heart muscle occur. This phenomenon is also called ventricular allorhythmia or supraventricular extrasystole. This condition can occur sharply and disappear throughout the day.

Bigeminia is a type of extrasystole, in which each correct contraction of the heart muscle is followed by an extraordinary. Based on this, bigeminia can be described as a condition in which contractions of the ventricles or atria do not occur in the pathways of the conduction system through which impulses are sent under normal conditions.

Normally, extrasystoles – premature excitations of the heart – are about 55 contractions per hour. We are talking about bigeminia when extrasystoles alternate with normal contractions of the heart muscle through one contraction. Such a condition is pathological if it lasts for several hours in a row during the day.

Depending on localization, two main forms of pathology are distinguished:

  • Ventricular or ventricular. Signals are given by the ventricle of the heart. This form is more often observed in the elderly.
  • Supraventricular, or atrial. The signal in this case comes from the atrioventricular node, that is, the supraventricular zone. This form of pathology is quite rare.

About 63% of patients with predisposing factors suffer from the ventricular form of bigeminia, and about 25% from atrial.

Depending on the frequency, pathological attacks are single (up to 5 signals per minute) and multiple (with a frequency of more than 5 pulses per minute).

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The state of bigeminia occurs as a result of the following factors:

  • abuse of strong coffee and tea;
  • emotional tension;
  • increased physical activity;
  • drinking alcohol, smoking;
  • pathology of the cardiovascular system (heart attack, angina pectoris, pericarditis);
  • irrational nutrition with a predominance in the diet of fried, fatty, salty;
  • intoxication of the body;
  • thyrotoxicosis;
  • electrolyte imbalance;
  • cervical osteochondrosis;
  • vascular dystonia;
  • congenital and acquired heart defects;
  • taking certain medications (Novocain, Adrenaline).

The development of pathology can also be triggered by surgical and diagnostic procedures performed in the chest area.


Extrasystole of the type of bigeminia, unlike most disorders in the cardiovascular system, is not expressed in angina pain, a feeling of compression in the heart. Even if the pain occurs, it is of a short-term nature.

Bigeminia is manifested in the following symptoms:

  • dizziness;
  • increased sweating;
  • bouts of nausea;
  • pallor of the skin of the face;
  • feeling short of breath;
  • increased anxiety and emotional excitability;
  • fainting conditions;
  • tremor;
  • inability to take a deep breath;
  • a feeling of short-term cardiac arrest;
  • sensation of a wave passing from the chest towards the neck or head;
  • darkening and flickering of flies before the eyes;
  • lethargy, fatigue.


Diagnosis is carried out by a cardiologist. To identify bigemini, the following activities are required:

  • blood and urine tests to identify the inflammatory process, assess the level of hormones of the adrenal glands and thyroid gland, as well as cholesterol and electrolytes;
  • ultrasound examination of the heart muscle to detect changes in the structure of the organ;
  • Holter monitoring, the essence of which is to obtain information on the work of the heart muscle during the day by fixing special equipment on the patient’s body, which will allow to establish the cause of bigeminia;
  • echocardiography: allows you to detect areas on which impulses are formed;
  • an electrocardiogram makes it possible to obtain visual data on normal contractions, pathological extrasystoles and their interaction;
  • chest x-ray allows you to assess circulatory failure;
  • An ECG with tests for exercise tolerance makes it possible to identify extrasystoles and assess the level of heart failure.

What are their differences?

The normal heart rate is 60-90 beats per minute. With its violation, extrasystoles (extraordinary contractions) occur at different intervals.

When they come from the sinus node, this is called sinus arrhythmia. In other cases, they are formed not in the sinus node, but in other parts of the myocardium.

The extraordinary contraction that appears after each normal impulse is called bigeminia. In other words, the ratio of correct and premature pulses is 1: 1. This is the most common heart rhythm pathology. It is recorded in 60% of cases.

When there is one extraordinary reduction in two correct contractions, this is trigeminia (2: 1).

With a ratio of 3: 1 – after three normal strokes, one wrong one occurs, this is quadrigemia.

And also there is pentaeminia (4: 1) and paired extrasystoles – double atypical contractions.

Some statistics

Extrasystoles of the type of bigeminia and trigenimia are combined into the concept of allorhythmia. There are also frequent ones – 3 in a row or more, and also paired (2 in a row). This extrasystole has its name – a short run of ventricular tachycardia.

According to statistics, the frequency of extrasystoles occurs in 69% of people. At the same time, 63% are ventricular, 25% are atrial, and the remaining cases are combinations of bi- and trigeminia. With a heart attack, ventricular bigemia occurs in 80% of patients.

What is an extrasystole by the type of bigeminia? Is this pathology dangerous and how to treat it?

Heart rhythm disturbances are always dangerous. When allorhythmic impulses occur, the correct movement of blood through the heart stops, areas with stagnation, turbulence occur.

Because of this, blood clots form in areas with “incorrect” blood flow, which, when torn off, cause fatal complications.

Extrasystole as bigeminia can cause the following complications:

  • Atrial fibrillation (a pathological condition caused by an irregular contraction of fibers in the myocardium).
  • Atrial flutter (atrial fibrillation, in which an enhanced rhythm of contractions prevails – the pulse reaches 200-400 beats per minute).
  • Heart palpitations caused by frequent contraction of the ventricles.
  • Ventricular fibrillation (chaotic, uncoordinated contractions).
  • Asystole – termination of the bioelectric activity of the myocardium. This is very dangerous for the patient, since it entails cardiac arrest, after which clinical death occurs.

When predicting the effects of bigeminia, the patient’s age, physical condition, and the presence of concomitant diseases must be taken into account. If a person does not have serious pathologies of blood vessels and heart tissues, then there will be no serious complications.

When a rhythm disorder occurs due to myocardial damage, it is necessary to treat the underlying disease. Ignoring it can lead to death.

Bigeminia alone is not a disease. The appearance of extrasystoles also occurs in healthy people. Extraordinary impulses sometimes occur, and then disappear within a day, which is recognized as the norm.

If a heart rhythm failure takes 5-15 minutes a day, this is not considered a pathology. But when the episodes of chaotic contractions are greatly lengthened, you should pay attention to this and go through an examination.

Transient rhythm disturbances are common in pregnant women. A rare extrasystole does not pose a threat to the fetus. After birth, the mother’s condition usually stabilizes.

Acquired bigeminia in children is associated with past infections, heart complications after complex diseases. In older children, it occurs against the background of intoxication with drugs and food poisoning.

Any version of extrasystole may indicate a dangerous violation of the heart. Ventricular bigeminia, in which the normal cardiac rhythm is replaced by an ectopic one, occurs against the background of acute myocardial ischemia or is a complication of chronic coronary pathology. In rare cases, the appearance of an irregular rhythm in a healthy person with vegetative disorders. In each case, it is necessary to perform the examination recommended by the doctor and start treatment for the disease on time.

Normally, rhythmic pulses causing contraction of the heart muscle are generated by the sinus node. The presence of premature or ectopic pulsation forms an arrhythmia: most often (in 60% of cases) there is ventricular extrasystole as a bigeminia, when after each normal contraction a pathological impulse that is not associated with the basic heart rhythm occurs. Extrasystoles can be:

  • supraventricular (sinus, atrial, atrioventricular);
  • ventricular.

The second most frequent occurrence is atrial extrasystoles (30%). In addition to the source of irregular rhythm, extrasystoles are divided by the frequency of abnormal contractions:

  • bigeminia of the heart (the ratio of the correct and ectopic rhythm 1: 1);
  • trigeminia (2 normal contractions 1 episode of ectopic);
  • paired extrasystoles (double irregular pulses);
  • group (3 or more).
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a – bigeminia; b – trigeminia.

If arrhythmia is detected, it is necessary to identify the causative factors of the disease in order to prevent dangerous complications: a rare and asymptomatic extrasystole rarely increases the risk of heart pathology, but frequent arrhythmic episodes and ventricular bigeminia can cause deterioration of the pumping function of the heart and the formation of acute circulatory disturbance in the coronary vessels.

In the vast majority of cases, arrhythmic disorders of the type of bigeminia occur against the background of the following types of cardiac pathology:

  • acute ischemic myocardial infarction;
  • congenital or acquired valve abnormalities;
  • rheumatic endocarditis;
  • cardiosclerotic changes in the myocardium;
  • myocarditis of any origin;
  • excess doses of drugs that affect heart function;
  • vegetative-vascular dystonia;
  • psycho-emotional disorders of the type of acute or chronic neurosis;
  • poisoning by household or chemical substances.

Post-infarction and post-inflammatory changes in the heart muscle with impaired coronary blood flow are the main causative factors for the appearance of extrasystoles by the type of bigeminia: a cardiologist or arrhythmologist knows what it is and how to treat a rhythm disorder, therefore, when symptoms appear and after an initial examination, one should strictly follow the advice of a treatment specialist pathology of the heart.

Rare and random episodes of ectopic rhythm usually do not appear in any way and become an accidental diagnostic finding during prophylactic ECG. The following symptoms are typical signs of extrasystole as bigeminia:

  • short-term loss of heartbeats that occurs against the background of normal rhythmic work of the heart;
  • chest pain associated with an episode of extrasystole;
  • deterioration of health with fainting.

A person who has experienced bouts of rhythm disturbance knows what extrasystole is and how pronounced the pathology of the circulatory system is manifested against the background of bigeminia. In chronic heart diseases with frequent and not severe bouts of rhythm disturbance, the following manifestations are possible:

  • weakness and lethargy, up to adynamia;
  • decreased attention and memory;
  • nausea, dizziness, and headaches;
  • sensation of pressure or contraction in the sternum;
  • episodes of respiratory failure according to the type of shortness of breath that occurs against the background of an arrhythmia attack (more on how to relieve an arrhythmia attack we wrote here);
  • psychological disorders (fear, panic, anxiety, emotional arousal);
  • pallor of the skin with the occurrence of excessive sweating.

The best option for detecting extrasystole is an electrocardiographic study. Bigeminia is easily detected on the cardiogram – extrasystole follows each normal episode of contraction. It is mandatory to determine the place of the ectopic rhythm: early extrasystoles from the ventricle are especially unfavorable when the R wave is superimposed on the T wave of the previous cycle. In addition to the ECG (normal and with stress tests), the following studies are necessary:

  • general clinical tests to assess the general condition of the body;
  • ECG monitoring during the day;
  • duplex ultrasound scanning of the heart and blood vessels.

With the results of the examination, it is necessary to visit narrow specialists for an advisory opinion on treatment tactics.

Medical tactic

The choice of drugs and principles of therapy depends on the causes of the appearance of extrasystoles. An important condition for successful treatment is a lifestyle change and compliance with the following doctor’s recommendations:

  • quitting smoking, drinking alcohol and coffee;
  • limitation of physical activity with a complete rejection of hard work;
  • obligatory full night sleep (you cannot work on a night shift);
  • changing the regime and diet with the addition of a sufficient amount of fruits and vegetables;
  • prevention of stressful situations.

Soothing medications taken continuously can provide a good effect for treatment. To correct heart pathology, you will need to take drugs with cardiotropic and antiarrhythmic effects. The main goals of therapy are to ensure comfort of life and to prevent the dangerous effects of extrasystole.

Risk of complications

The following types of pathology are prognostically unfavorable:

  • bigeminia;
  • paired or group episodes;
  • early ventricular extrasystoles.

The treatment reduces the risk, but does not guarantee the complete prevention of seizures, therefore, each person with extrasystole should be regularly observed by a doctor and strictly follow the preventive advice of a specialist.


Bigeminia often becomes a concomitant symptom in disorders of the nervous and autonomic nervous system, organic heart damage, intoxication. Atrial and ventricular extrasystoles in single quantities are considered the norm and can occur in healthy people. They do not show themselves. In a healthy person, they can be 30-60 per hour (720-1440 per day).

Alorrhythmia, as well as frequent paired extrasystoles, are not considered the norm and need to be identified etiology. All predisposing factors are divided into cardiac and extracardiac, organic and functional. The main causes of bigeminia and trigeminia:

  • heart attack;
  • overdose of cardiac glycosides;
  • heart defects – congenital and acquired;
  • treatment with Novocainamide, Quinidine, Novocainum and adrenaline;
  • taking beta-blockers, inhaled bronchodilators;
  • the use of certain types of anesthesia – cyclopropane, chloroform;
  • acute intoxication;
  • rheumatic endocarditis;
  • consequences of myocarditis – after inflammation there are scars that provide the basis for the occurrence of pathological impulses;
  • electrical stimulation of the heart;
  • coronary angiography;
  • heart sounding;
  • heart surgery;
  • post-infarction cardiosclerosis that occurs against the background of myocardial scars.

If we are only talking about vegetative disorders and there is no organic matter, then treatment usually consists of taking sedatives. Functional bigeminias appear with cervical osteochondrosis, dystonia, stress, overwork at work, coffee abuse, neurosis, a “sports heart”, smoking, prolonged hyperthermia, prevalence of fatty and spicy dishes in the menu.

Extracardiac causes include genetic abnormalities, adrenal gland disorders, thyroid disease (hyperfunction), autoimmune diseases, and water-electrolyte disorders.


With allorhythmia, extraordinary impulses appear not in the sinus node, like normal contractions, but in other parts of the myocardium.

With bigeminia and trigeminia, the focus of the ectopic signal is located in the atrium or ventricles.

Depending on this, arrhythmias are of two types:

  • Ventricular (ventricular). Excitatory impulses come from a source located in the ventricles. This is the most common type of pathology – it occurs in 60% of people with bigeminia.
  • Supraventricular (atrioventricular). Ectopic impulses form in the atrium or atrioventricular node located in the atrial septum.

Pathology of the ventricular type is common in the elderly. Often, it indicates existing myocardial diseases.

The supraventricular is more characteristic of young patients. They have a violation of the heart rhythm due to stress, increased physical exertion.

If one of the types of allorhythmia is detected, an in-depth examination should be carried out to exclude a serious heart pathology and prevent complications.

Why are electrolytes and minerals important?

They must be in a certain balance. Ions Ca, Mg, Na, K with systoles and diastoles constantly penetrate into the cells and exit them in a certain sequence. Due to this, a rhythmic contraction of the heart muscle occurs. If their ratio changes, the rhythm goes astray.

Ventricular extrasystole with bigeminia in 70% of patients is combined with ischemia. For differential diagnosis after 40 years, coronary angiography is performed. Bigeminia due to heart attack and ischemia gives a bad prognosis.

The provoking factors

The reasons why allorhythmia occurs are divided into external and internal.

External include functional causes (the functions of an organ fail without destroying its structure). To internal – organic disturbances.

And it is also possible idiopathic development of pathology, when the cause could not be identified.

The functional causes of rhythm disturbances can be caused by mental disorders (stress, neurosis) or intoxication of the body.

Extrasystoles, provoked by intoxication, arise due to:

  • chemical poisoning of the body;
  • frequent smoking or alcoholism;
  • abuse of coffee, strong tea, energy;
  • antibiotic treatment for severe infections;
  • long-term use of steroids;
  • overdose of cardiac glycosides;
  • thyroid dysfunction.

Poisoning the body provokes ventricular type bigeminia.

Organic factors include the following diseases:

  • Coronary heart disease.
  • Inflammation of the tissues of the heart muscle.
  • Atherosclerosis is the appearance of plaques on the walls of the coronary arteries that impede blood circulation.
  • High blood pressure.
  • Cardiosclerosis.
  • Defects of the mitral and aortic valves.
  • Cardiomyopathy is a chronic neuromuscular pathology of the heart.
  • Pulmonary heart – an increase in the right heart due to lung disease.
  • Damage to the serous membrane of the heart.
  • Disruption of the heart due to strong physical exertion.
  • Heart defects.

Sometimes a heart rhythm failure causes surgery. As well as extrasystoles can appear due to coronary angiography, sensing of the heart muscle.

Bigeminia Forms

In order for the ventricle to contract and systole to occur, an electrical impulse is needed from the sinus node. With extrasystole bigeminia, their rhythm and appearance with the sinus node are not connected, for them he is not a pacemaker. According to the location of the focus, giving out impulses, there are 2 forms of violation.

  1. Ventricular bigemia – signals are provoked in the ventricle of the heart. The phenomenon is more characteristic of the elderly and is associated with organic myocardial lesions.
  2. Supraventricular form – the signal comes either from the atrium itself, or from the AV node (atrioventricular). The disorder is often functional, occurs in young people with physical exertion and stress. This condition is dangerous for children, because the control of the sinus node may be lost.

Bigeminia, as well as trigeminia, are medical terms that reflect abnormal heart rhythms. This is not a heart block or bradycardia. This is a situation when an additional contraction wedges into the usual rhythm. And maybe not one. In fact, a malfunction occurs in the system for conducting pulses of heartbeat control.

Such failures are highly undesirable, since the consequences can be bad. Especially in the case of an existing violation in the heart muscle. And the feeling of fluttering of the heart carries great anxiety. In addition, a violation of the heart rhythm creates a risk of blood clots inside the heart. Formed clots can travel through the cardiovascular system, causing serious problems. Better to see a doctor.

  • Atrial systole – contraction.
  • Ventricular systole.
  • Diastole – relaxation.

Rhythmic repetitive heart contractions are called heart rhythms, or heart rate.

What causes the normal heart rhythm to form is called the pulses that occur in the sinus node – the pacemaker.

The sinus node is a part of the conduction system of the heart, the cells of which are localized at the junction of the superior vena cava and the right atrium. It is the sinus node that sets the normal rhythm of the heart and transmits impulses through the same amount of time to other cellular elements.

In the event of a failure at any level of the cardiac conduction system, cardiac arrhythmias occur.

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Any violation of the heart rate is called arrhythmia. All possible arrhythmias are divided into:

  • Violation of automatism.
  • Violation of excitability.
  • Impaired conductivity.
  • Mixed.

Those forms of arrhythmia that are accompanied by impaired automatism are:

  1. Nomotopic – in such cases, the pacemaker is located in the sinus node:
    • Sinus tachycardia.
    • Sinus bradycardia.
    • Sinus arrhythmia.
    • Sick sinus syndrome.
    • Sinus arrhythmia of non-respiratory origin.
  2. Heterotropic – in these cases, the pacemaker is located outside the sinus node:
    • Atrial rhythm.
    • Idioventricular rhythm.
    • Atrioventricular rhythm.

Heart rhythm disturbances that occur due to pathological excitability (often due to premature excitation) are divided into:

  1. Extrasystoles:
    • Quantitative – monotopic, polytopic.
    • Temporary – early, late, intermediate (interpolated).
    • Based on the source – atrial, ventricular, atrioventricular.
    • In frequency – single (up to 5 / min), multiple (more than 5 / min), group, paired.
    • By ordering – allorhythmias (bigeminia, trigeminia, quadrigimenia), disordered.
  2. Paroxysmal tachycardia:
    • Atrial
    • Atrioventricular.
    • Ventricular.

Arrhythmias in which conduction disturbance is observed:

  • Extension of conductivity.
  • Decreased conduction (heart block).

Violations of the rhythm, which combine several manifestations:

  • Atrial flutter.
  • Atrial fibrillation.
  • Ventricular flutter.
  • Ventricular fibrillation.

One of the most common types of arrhythmias are extrasystoles.

A change in the basic rhythm and extrasystoles in a strictly defined sequence is called allorhythmias.


Bigeminia and trigeminia do not have specific symptoms. This means that there are no pronounced signs by which pathology can be determined.

Manifestations of heart rhythm disturbances are similar to other cardiac pathologies: discomfort behind the sternum, a feeling of interruptions in the work of the heart, a general deterioration in well-being.

Symptoms are divided into cardiac and somatic. Patients suffer seizures differently. Their well-being depends on the physical condition, individual characteristics, age.

Strong tremors of the heart, alternating with fadingLethargy, weakness
Feeling of lack of airVisual disturbances
Heaviness, chest pressureOccurrence of anxiety
Pallor of the skinDecreased sensitivity of arms and legs
Increased sweatingRarely – speech impairment

Such arrhythmia is manifested by two types of symptoms: cardiological and neurological. The first type is manifested by such symptoms:

  • the skin turns pale;
  • there is a fear of death, inner anxiety;
  • nausea and vomiting;
  • lack of air;
  • contractions of the heart, feeling of fading, stopping;
  • cold sweat;
  • discomfort behind the chest.

The following neurological signs are distinguished:

  • constantly want to sleep;
  • fatigue and lethargy appear;
  • impaired vision and speech;
  • feelings of anxiety and anxiety;
  • dizziness;
  • sometimes fainting is observed;
  • sensitivity is lost;
  • impaired motor activity of the limbs.

There are times when supraventricular or ventricular bigemia is not accompanied by any of the symptoms. Each case of the disease must be diagnosed in order to start treating the disease in time.

Symptomatic manifestations

Some well tolerate arrhythmia, while others start to panic. If bigeminia is not single, the following manifestations may be present:

  1. Shortness of breath, shortness of breath, shortness of breath.
  2. Pale skin.
  3. Feeling of fear of death.
  4. Cold sweat on forehead, nausea.
  5. Adinamia.

Pain is very rare, but there are very unpleasant feelings of interruptions in the heart, fading or falling, flutter, constriction, discomfort. The pulse becomes arrhythmic. It can become very low – 30-40 beats per minute, but with auscultation of the heart, everything comes back to normal. This is an imaginary bradycardia. It appears because the next extrasystole is not always creating a pulse wave, which reaches the periphery.

  • fainting conditions;
  • drowsiness;
  • veil before the eyes;
  • dizziness;
  • aphasia (speech impairment);
  • transient hemiparesis (one half of the body is affected).

The main characteristic of bigeminia and signs of cardiac dysfunction

Heart problems are the most common in the modern world. These include bigeminia and trigeminia, which are observed in almost 70% of people. Therefore, it is important to know the symptoms of the disease in order to detect it in time and consult a doctor.

Ventricular extrasystole as bigeminia or trigeminia is a heart rhythm disorder. In this case, the contraction of the ventricles of the heart or atria does not occur in those places of the conduction system in which it occurs in healthy people.

Electrocardiography is a reliable way to detect bigeminia and other types of allorrhythmias.

Heart rhythm disturbance is easily recognized on the charts of the cardiogram. Upon examination, the doctor sees that behind each normal heart contraction there is an extraordinary impulse. It looks like two QRS prongs nearby. They are separated by a horizontal line showing relaxation of the heart muscles.

The shape of the pulse is determined by the change in electric forces when overcoming the excitation wave in the myocardium. Extrasystole has a long narrow tooth preceding the normal QRS complex. Its frequency is less than that of a pulse coming from the sinus node.

When decoding the ECG, the cardiologist should pay attention to the site of the occurrence of a premature impulse. Of great concern is the early ventricular impulse (when the next tooth is superimposed on the previous tooth).

In the case when rare extrasystoles are recorded on the ECG and bigeminia is not systemic, but the patient complains of a heart, he is sent for an additional examination.

Diagnostic measures

The most informative research method is Holter monitoring. Sensors are installed on the patient’s body, which record an ECG during the day, and the patient leads a normal lifestyle. Then you can detect the presence of arrhythmias in general and the frequency of allorrhythmias. ECG, echocardiography, intracardiac electrophysiological examination are also used.

With bigeminia, the pulse may lag behind heart rate – this is called a pulse deficiency. Therefore, the doctor must feel the pulse. Auscultation is heard an additional tone of extrasystole. Echocardiography can determine the presence of organic lesions in the heart.

Intracardiac electrophysiological examination is used for severe arrhythmias. Through a vein, electrodes are inserted into the heart that record the electrical activity of different parts of the myocardium. This allows you to identify the source area of ​​extrasystole.

An ECG is the easiest and most common way to detect bigeminias. An ECG is detected in the form of regular alternations of normal and premature contractions. They look like pairs of complexes of QRS teeth on the ECG and are separated by segments of ventricular relaxation. Pass along the contour.

With the supraventricular form, the extrasystole teeth on the ECG are not changed. With the ventricular variant, the complexes are expanded and deformed.


With allorrhythmia, in addition to conventional electrocardiography, comprehensive studies are carried out to identify its causes.

To clarify the degree of rhythm disturbance, an ECG is performed according to Holter. This is a diagnostic method in which prolonged registration of the electrical activity of the heart is carried out.

Holter daily monitoring is an informative examination that allows you to effectively identify cardiovascular pathologies.

Additionally, the patient is prescribed:

  • Clinical and biochemical blood tests. These studies make it possible to establish the presence of an inflammatory process in the body, the state of metabolism.
  • Ultrasound examination of the heart muscle. It allows you to detect changes in the structure of the myocardium.
  • ECG with stress tests. It is prescribed to compare cardiac arrhythmias with physical activity.

From this article you will learn: what is bigeminia, the causes of this heart rhythm disturbance. Symptoms and treatment.

The author of the article: Yachnaya Alina, oncologist surgeon, higher medical education with a degree in General Medicine.

Bigeminia is a variant of allorrhythmia of the heart (the correct alternation of extrasystoles and normal complexes), in which each normal beat is accompanied by extrasystole – premature contraction of the heart muscle.

Normally, the pacemaker is the sinus node located in the atria. Extraordinary impulses can come from the ventricles, less often from the atria, forming ventricular or atrial extrasystoles. Depending on the source of extrasystole, a supraventricular or ventricular form of pathology is isolated. In the first case, impulses leading to premature contractions and the development of bigeminia are formed in the atria, in the second – in the ventricular myocardium.

Bigeminia should not be considered a disease. Often such a rhythm disturbance is not dangerous. When determining the degree of risk, the reasons leading to extrasystole should be considered:

  • For example, if an allorhythmic extrasystole was a consequence of myocardial infarction, it may indicate a significant severity of the condition.
  • Against the background of bigeminia with a heart attack, the risk of developing ventricular arrhythmias increases, which can lead to fatal consequences.
  • Periodic short-term episodes of bigeminia without an organic pathology of the heart can be regarded as safe and do not require antiarrhythmic therapy.

This pathology can be completely cured.

A cardiologist is involved in the treatment of bigeminia. If the cause of the pathology is associated with diseases of other organs (thyrotoxicosis, neurocirculatory dystonia), treatment is required by the appropriate specialists: endocrinologist, neurologist. If there are indications for surgical treatment of arrhythmias, a cardiac surgeon consults patients.

Extrasystoles may be associated with functional disorders, organic myocardial changes and toxic effects. Rare extrasystoles often occur in healthy people. Bigeminia is usually detected in patients with structural changes in the myocardium or the presence of valvular defects.

Functional reasons for the development of bigeminia are also possible:

  • smoking;
  • psycho-emotional stress;
  • the effects of caffeine or alcohol;
  • cardiopsychoneurosis;
  • electrolyte disturbances.

In some cases, the cause of the condition cannot be determined. This bigeminia is called idiopathic.

Organic pathology causes include diseases that lead to changes in the heart muscle in the form of dystrophy (structural and metabolic disorders), necrosis (necrosis of the myocardial site), sclerosis (replacement of myocardial connective tissue). Toxic effects can also affect the electrophysiological properties of the myocardium, which often leads to the development of rhythm disturbances.

Organic Causes of BigeminiaPathological effects that can cause pathology
Myocardial infarctionCardiac Glycoside Overdose
Arterial hypertension (high blood pressure)Toxication for infectious diseases
Myocarditis (inflammation of the heart muscle)Fever
Cardiomyopathy (damage to the heart muscle with impaired function, not associated with coronary artery pathology, hypertension, or valve defects)Side effects of antiarrhythmic drugs
CardiosclerosisThyrotoxicosis (increased thyroid activity)
Heart failureReaction to beta-adrenostimulants, aminophylline and some other drugs
Pulmonary heart
Genetic abnormalities
Amyloidosis, sarcoidosis with myocardial damage
“Athletic heart”
The consequences of heart surgery
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Ventricular extrasystoles in about 2/3 of cases are associated with coronary heart disease (CHD). Therefore, when detecting premature ventricular complexes after 40 years, the association of arrhythmias with coronary heart disease can be excluded only by the results of coronary angiography – a study of the state of blood vessels supplying the heart.

The development of rhythm disturbances due to myocardial infarction or other forms of coronary heart disease worsens the prognosis of the disease.

Symptoms of Bigeminia

Both with the ventricular and supraventricular forms of bigeminia, subjective sensations differ in different people. Some patients tolerate this type of arrhythmia well, while others feel much worse, feelings of anxiety and fear arise. With stable bigeminia, extrasystoles may not be felt, but more often with pathology there are certain manifestations of discomfort in the chest or neck.

The following symptoms may bother the patient:

  1. The feeling of interruptions, pauses between heart contractions, which may resemble a fall from a height or a sinking heart.
  2. Anxiety, especially when extrasystoles occur at night.
  3. Shortness of breath, shortness of breath.
  4. Dizziness, decreased blood pressure at the time of the attack of allorhythmia.
  5. Pain in the heart.

In addition to symptoms directly related to extrasystoles, clinical manifestations of the pathology that caused the appearance of arrhythmia can be observed. Sustainable bigeminia can lead to the development of heart failure, cause disturbances in the heart muscle and its work.


Pulse – the frequency of oscillation of the walls of blood vessels, determined by palpation. With bigeminia, the pulse may slow down and amount to less than 40 beats per minute. Moreover, it does not coincide with the heart rate – this parameter is determined when listening to tones in the heart region, and with bigeminia it usually corresponds to the norm – 60–80 per minute. That is, for example, on the neck or on the wrist you can count 40 beats per minute, and in the region of the heart – 60–80 beats.

This phenomenon is called heart failure. When listening to cardiac activity, an additional tone of extrasystole is determined, with bigeminia it is usually enhanced.

Instrumental research methods for bigeminia:

  • Electrocardiography – registration of electric fields formed as a result of cardiac activity.
  • Echocardiography is an ultrasound scan that allows you to identify organic cardiac pathology.
  • Holter monitoring is a technique for recording cardiac electrical activity during the day, which allows to identify the frequency of attacks of allorhythmia and the presence of other rhythm disturbances. To do this, a device is fixed on the body that records the ECG during normal patient activity.
  • Intracardiac electrophysiological examination is a method used in severe arrhythmias when it is necessary to identify the myocardial site, which is the source of extrasystole. During the study, electrodes are inserted through the vein into the heart, which record the electrical activity of various parts of the myocardium.

Electrocardiography is a simple and effective method to detect the presence of bigeminia. If the examination is carried out with a constant form of pathology or during an arrhythmia attack, a sequential alternation of normal and premature pulses is detected on the ECG. They look like pairs of complexes of ECG teeth formed by changes in electric fields during the passage of an excitation wave through the myocardium.

The complexes are divided among themselves by segments corresponding to relaxation of the myocardium of the ventricles and atria and passing along the isoline (the level conventionally assumed to be zero). With the supraventricular form, the ECG teeth corresponding to extrasystoles are not changed. With the ventricular version of bigeminia, expansion and deformation of the complexes is observed.

Treatment of pathology

In some cases, bigeminia can be completely eliminated. This happens in situations where it is possible to eliminate the cause of allorhythmia, for example, thyrotoxicosis, myocarditis, infectious disease, electrolyte imbalance. In severe cases, get rid of bigeminia allows surgical intervention – the destruction (ablation) of the focus of pathological impulses using high-frequency current.

  1. For any form of bigeminia, treatment of the pathology that caused the rhythm disturbance, elimination of the causative factors of arrhythmia is indicated.
  2. Useful refusal of alcohol, smoking, strong tea, coffee.
  3. It is recommended that a healthy lifestyle, the elimination of psycho-emotional stress.
  4. In case of severe subjective tolerance of attacks of bigeminia, drugs with a calming effect are recommended: tinctures of hawthorn, motherwort, tranquilizers (phenazepam, clonazepam).

Antiarrhythmic drugs for any type of extrasystole, including bigeminia, are used according to strict indications. According to studies, occasionally occurring episodes of bigeminia in themselves do not harm the body and rarely lead to circulatory disorders.

But taking antiarrhythmic drugs can lead to side effects. The most dangerous of them:

  • increased risk of sudden cardiac death;
  • arrhythmogenic effect – an increase in existing arrhythmia or the occurrence of another rhythm disturbance;
  • dizziness, fainting, an increase in heart failure, a decrease in the number of white blood cells and other negative reactions.

Deciding on the need for antiarrhythmic therapy depends on a risk assessment. Firstly, with supraventricular bigeminia, there is a danger of developing supraventricular tachycardia, a rhythm disturbance in which the frequency of contractions reaches 140–180 per minute. The condition is dangerous due to the possibility of developing heart failure and requires urgent measures to normalize the rhythm.

Principles of treatment

Typically, bigeminia does not require treatment. Single manifestations of such circulatory disorders are not a diagnosis. Need cardiac pathology. Usually it’s enough to remove the provoking factors so that everything works out, often psychological or emotional.

It is useful to give up smoking, strong coffee and tea. If this is a chronic focus of infection, it must be sanitized. With neurogenic arrhythmias, a neurologist can prescribe sedatives such as “Phenazepam”, valerian, hawthorn, motherwort, “Clonazepam”, “Nozepam”, etc.

If the cause is intoxication with drugs, they are immediately canceled. Antiarrhythmics are prescribed only for organic heart lesions, but only according to strict indications and after Holter monitoring.

When determining the degree of risk of extrasystoles, its causes themselves are taken into account: for example, if allorhythmic extrasystole occurred after a heart attack (as a consequence of it), it indicates a significant severity of the condition. And if it occurs with myocardial infarction itself, then the risk of developing ventricular arrhythmias increases.

preventive measures

Prevention of allorhythmia consists in procedures for the general improvement of the body:

  • Refusal of bad habits (smoking, drinking).
  • Performing moderate physical exertion with the exception of weight lifting.
  • Normalization of nutrition. It is necessary to refuse harmful food – fatty, fried, spicy, in favor of natural – vegetables, fruits, herbs, dietary meat, fish.
  • Stabilization of the mental state. Well healing baths, walks in the fresh air help.
  • Therapeutic physical education, spa treatment

To prevent heart disease, prevention is essential.

A correct lifestyle and a comfortable mental state of a person are the key to his good health.

Indicated for use

These funds are assigned in the following cases:

  • frequent bigeminia, causing circulatory disorders;
  • severe tolerance to attacks of extrasystoles;
  • deterioration of the functional parameters of the heart.

In supraventricular bigeminia, they are prescribed: beta-blockers (Anaprilin, Atenolol, Metoprolol) or AK (calcium antagonists) – Verapamil, Diltiazem. They normalize the rhythm of the heart.

In case of ventricular extrasystole, “Amiodarone” and beta-blockers (“Sotalol”, “Nebilet”, “Coronal”, “Concor”) are prescribed. If there is no connection with coronary heart disease, class 1 antiarrhythmics are used (“Propafenone”, “Etatsizin”, “Etmozin”). These drugs relieve tachycardia, reduce the conductivity of pathological impulses.

Urgent care

With sudden frequent bigeminia or trigeminia, intravenous administration of Cordarone, Lidocaine and Quinidine becomes mandatory. If antiarrhythmics are contraindicated to the patient or they are ineffective, RFA (radiofrequency ablation) is used. This is an endoscopic or catheter treatment for arrhythmias. It consists in cauterizing additional pathways for conducting pathological impulses.

The catheter itself radiates the current, it neutralizes the existing inflammatory focus and creates a scar in its place, which does not interfere with the further work of the heart.

Are there complications of bigeminia? They are possible with any localization of bigeminia. Atrial extrasystole may be complicated by atrial flutter or pass into atrial fibrillation, and ventricular extrasystoles (VES) – into paroxysmal ventricular tachycardia, into ventricular fibrillation and lead to asystole (cardiac arrest). Therefore, it is necessary to timely treat those diseases that were the cause of the symptom of bigeminia.

What are the forecasts

Bigeminia is a non-dangerous situation in the absence of organic pathology. A prognostic classification of ZhES (bigeminia and trigeminia) according to Laun from 1971 has been created, which is used by all practical cardiologists:

  • Grade 1 – monoform ZhES – no more than 30 single extrasystoles per hour;
  • 2 – more than 30;
  • 3 – polymorphic ZhES and polytopic extrasystoles;
  • 4 A – paired extrasystoles;
  • 4 B – 3 or more ZhES in a row or ventricular tachycardia;
  • 5 – “early” extrasystoles, when an extraordinary contraction occurs even against the background of a continuing normal contraction of the heart.

The first 2 classes in the forecast are favorable. Third to fifth are unfavorable because they can cause a transition to more severe rhythm disturbances.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.