Bigeminy

[liz2]

I am a 41 yr old female. My dr noticed my pulse was slow (48) a few weeks ago and had me do an EKG. The EKG showed I was in bigeminy and my dr sent me to a cardiologist that day. I had an echo and a 24 hr holter. The echo was “generally unremarkable” with an EF of 50%, which the dr said was slightly weakened, but showed no reason for the bigeminy.

The holter showed over 11,000 PVC’s in the 24 hours all unifocal, no couplets or runs. I was in bigeminy or trigeminy a lot of the time. My lowest heart rate on the holter was 53. I then had a nuclear stress test. I was in bigeminy when the test started, but went to a normal rhythm at a higher heart rate.

I was able to get a copy of an EKG I had 18 months ago and it showed the same problems I am having now. The dr at that time did not tell me the EKG was abnormal. I also have a baseline EKG from 6 years ago that was normal.

My blood pressure has been low for the last month, usually 110/60, and was 105/55 right before I got on the treadmill for my stress test. My blood pressure had always been 120/70 or 80 until recently.

I have a couple of questions for you. I have been short of breath and had a lot of fatigue the last few months - can being in bigeminy cause this?
What causes this arrhythmia to develop in an adult without heart disease? Have you seen this before and what course of action would you recommend next? Also, what can I expect in the long term?

Thank you for your time

[Michael J. McWilliams, M.D.]

only if you have symptoms from the low blood pressure.

[liz2]

Thank you so much for the information. I do not feel the PVC's, so I will probably go the conservative route for now. I am supposed to have a follow up holter and echo in six months.

Do I need to worry about low blood pressure with the medications since I am already on the low side?

Thank you for your time.

[Michael J. McWilliams, M.D.]

I have been short of breath and had a lot of fatigue the last few months - can being in bigeminy cause this?

It could.  Continuous PVCs can cause people of have symptoms of palpitations or weakness.  If the PVCs are constant, it could account for symptoms.

What causes this arrhythmia to develop in an adult without heart disease?

That is the million dollar questions.  We don't know why so people have them and others do not.

Have you seen this before and what course of action would you recommend next?  Also, what can I expect in the long term?

I have.  Medical management is the first step.  Beta blocker first, if that does not help, a calcium channel blocker is tried.  If neither medication improves your symptoms and you have PVCs that are all the same shape (morphology), an ablation can be considered if the symptoms really bother you.  The other reason to think about an ablation is that sometimes PVCs of that number per day can actually cause heart function to decrease -- this is rare but it can happen.  What you don't know is if the heart function is reduced because of the PVCs or if the PVCs are caused by the low normal heart function.  In cases where PVCs cause decreased heart function, the heart function usually improves after the ablation.

The other options is to treat conservatively with medication and follow you heart function (EF).  If your EF is stable, continue conservative treatment.  If your EF decreases, consider an ablation.

I hope this helps.  Thanks for posting.