What Is Bigeminy?

Bigeminy is a cardiac rhythm where a normal heartbeat alternates with an abnormal beat. The normal beats typically come from the heart's internal pacemaker (sinus node). The irregular beats are generated by other areas of the heart (ectopic beats).

When your heart beats, an electrical signal is sent through the heart to pump blood throughout your body. With abnormal beats, you may only have electrical activity without the blood pumping when you may have skipped a beat. Other times, bigeminy can feel like you have extra heartbeats.

This article discusses the symptoms, causes, diagnosis, and treatment of bigeminy.

Bigeminy Symptoms

Bigeminy symptoms are similar to other arrhythmias and can be wide-ranging. Some people do not have any symptoms at all when they have bigeminy. Others may have a sensation of a missed heartbeat or a fluttering feeling in the chest called palpitations.

If the number of normal beats in a minute is slow (bradycardia), symptoms may include dizziness, lightheadedness, fainting, or low blood pressure.

Some more common signs of bigeminy and other arrhythmias also include:

• Fatigue
• Weakness
• Pounding in the chest
• Shortness of breath
• Anxiety
• Abnormal heart rates
• Sweating

Causes

Your heart adapts to different life conditions. Your heart rate and heartbeat strength are expected to change during exercise, stress, illness, sleep, and relaxation. However, you can develop an abnormal heart rhythm, which may increase your risk for serious outcomes like stroke or heart attack.

Bigeminy can have many causes. Some of the potential causes of arrhythmias include:

• High blood pressure
• Heart disease
• Congenital (birth) heart disease
• Alcohol
• Recreational drugs (cocaine and amphetamines are particularly risky)
• Medications (including some designed to control heart rate)
• High cholesterol levels
• Abnormal levels of electrolytes in the blood, including potassium, magnesium, and calcium

Sometimes, your healthcare team will not identify a specific cause for your condition, but effective treatments can still exist.

Diagnosis

The primary way to diagnose cardiac bigeminy is with an electrocardiogram (EKG or ECG). This test uses stickers on the chest to record the heart's electrical activity. It may help the electrical rhythm cardiologist (electrophysiologist) understand the part of the heart responsible for the abnormal beats.

Specific activities or conditions may trigger bigeminy and other arrhythmias. One way to watch your heart over time is to wear an ambulatory cardiac monitor, sometimes called a Holter monitor. Some newer wearable devices can record over weeks or even years to help your provider with an accurate diagnosis. In some cases, wearable fitness devices like a watch or ring may also help to record your heart rate.

If needed, your healthcare team can recommend additional tests to help with the diagnosis, including:

• Cardiac stress test
• Tilt table test
• Electrophysiology study
• Echocardiogram
  

Treatment

Many times bigeminy and other arrhythmias are left untreated, especially if they are not causing symptoms. Your healthcare team will review the benefits of any proposed treatment and its side effects so you can decide what is best for you.

Monitoring

If you have no or rare symptoms, your provider may recommend monitoring yourself. Regular pulse and blood pressure checks can help to identify any changes in your condition. Reach out to your provider as instructed or with any changes or concerns.

Lifestyle Adjustments

There may be some actions you can take to decrease your risk for bigeminy and other arrhythmias. These changes may also help decrease how often arrhythmias occur. Your healthcare team may recommend that you:

• Stop smoking
• Reduce or eliminate alcohol
• Lose excess weight
• Follow a heart-healthy diet
• Exercise regularly

Medication

Many different medications are available to help control heart rate and rhythm. Your healthcare provider will review your medical history and tests to decide what medication to use first. You may need to try multiple medications to find the proper treatment for your health situation. Your healthcare team will work with you to guide you in the process.

Pacemaker

If bigeminy makes your heart rate too slow, your provider may recommend a permanent pacemaker to maintain a minimum heart rate. Inserting a pacemaker is a surgical procedure usually done at a medical center, and many stay overnight. Your healthcare team will discuss what to expect.

Coping

Living with an abnormal heart rhythm may be challenging. It can cause nervousness or anxiety to think about your heart not beating "normally." However, many people can live a long and healthy life with arrhythmias, and treatments are available.

Speak with your provider to ensure you understand the results of your tests, your diagnosis, and the treatment options you can consider. If you need help quitting smoking, losing weight, or making other adjustments to your lifestyle, your medical team can assist.

For some people, speaking with a counselor might be helpful to process any strong emotions that occur when you find out about your bigeminy.

Summary

Bigeminy is a type of cardiac arrhythmia. People with bigeminy have periods where a normal heartbeat alternates with an abnormal one. Symptoms range from none to serious, and any changes should be reported to your provider. Bigeminy may have a known cause, or it may occur spontaneously. Your healthcare team will review possible treatments if you need them.

A Word From Verywell

Palpitations or dizziness can be a sign of abnormal heart function. Although potentially frightening, seek proper medical care right away so you can find out what is happening and get treatment. Your healthcare provider will share the results of any tests and discuss your diagnosis with you. Chest pain, trouble breathing, or passing out can be signs of a serious issue that needs immediate medical attention.