Bigeminia is a variant of ventricular extrasystole. And extrasystole itself is an extraordinary premature contraction of the heart. This condition is called the ectopic rhythm of the heart.
Bigeminia is a 1: 1 ratio of normal to ectopic rhythm. With the pathology under consideration, the reduction signals do not appear in the foci and paths along which the usual impulse is conducted. There are ventricular and supraventricular (atrial) extrasystoles.
The essence of pathology
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.
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.
Causes of occurrence
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). When such extraordinary contractions alternate with normal 1: 1, they are called bigeminia, (“bi-” means “two”). In other words, there is a normal contraction, then extrasystole, then again normal, etc.
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, Novocaine 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;
- coronarography;
- 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.
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.
Bigeminia Forms
In order for the ventricle to contract and systole to occur, an electrical impulse is needed from the sinus node. With extrasystole of 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, 2 forms of violation are distinguished.
- 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.
- 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.
Symptomatic manifestations
Some well tolerate arrhythmia, while others start to panic. If bigeminia is not single, the following manifestations may be present:
- Shortness of breath, shortness of breath, shortness of breath.
- Pallor of the skin.
- Feeling of fear of death.
- Cold sweat on forehead, nausea.
- 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. Interruptions are felt in the form of a weak blow, followed by a strong one. The main symptom is the fear of death, which occurs in almost everyone. Anxiety is characteristic of night attacks.
Neurological symptoms:
- fainting conditions;
- drowsiness;
- veil before the eyes;
- dizziness;
- aphasia (speech impairment);
- transient hemiparesis (one half of the body is affected).
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.
Treatment principles
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 an 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.
Antiarrhythmic therapy
Why such strict rules? Because drugs in this group give many dangerous side effects:
- increase the risk of death from increased existing arrhythmias or cause another arrhythmia themselves (arrhythmogenic effect);
- there is an increase in heart failure, fainting;
- leukopenia develops, etc.
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.
When supraventricular bigeminia is 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. It can be carried out only with precisely established localization of the focus of extrasystole. The electrodes introduced through a vein conduct a radio frequency effect on the source of arrhythmia, destroying it.
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 can 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.