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# Help in understand bigeminy and trigeminy

As I udernstand it it goes like this (note A=atrial contraction, V=ventricular contration, Vpvc = early ventricular beat)

Bigeminy:
(A-V-Vpvc), (A-V-Vpcv), (A-V-Vpvc), (A-V-Vpvc)

Trigeminy:
(A-V), (A-V-Vpvc), (A-V), (A-V-Vpvc), (A-V-Vpvc), (A-V), (A-V-Vpvc)

Couplet:
(A-V-Vpvc-Vpvc)

Triplet (V-Tach)
(A-V-Vpvc-Vpvc-Vpvc)

Is this correct?
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From a post I did a while back.  Hopefully this helps further.  also, triplet is not VTACH.  vtach is 4 or more in a row, a.k.a > 3 in a row

Lines (left out the AV node firing for the sake of simplicity)
1=SA node firing a beat
2=Atrium contracting
3=Ventricle contracting

NSR
1.  SA-------SA-------SA-------SA-------SA
2.  ---A----------A---------A----------A---------A
3.  ------V---------V---------V----------V---------V

NSVT
1.  SA-------SA-------SA-------SA-------SA
2.  ---A---------A---------A----------A---------A
3.  -----VVVVV-pause--V---------V----------V

A single PVC
1.  SA-------SA-------SA-------SA-------SA
2.  ----A---------A---------A----------A---------A
3.  ------V--V-pause------V----------V----------V

Couplet
1.  SA-------SA-------SA-------SA-------SA
2.  ---A---------A---------A----------A---------A
3.  ------V-VV-pause----V----------V----------V

Bigeminy
1.  SA-------SA-------SA-------SA-------SA
2.  ---A---------A---------A----------A---------A
3.  ------V---V-pause----V----------V--V--pause

Trigeminy
1.  SA-------SA-------SA-------SA-------SA-------SA-------SA-------SA-------SA
2.  ---A---------A---------A----------A---------A----------A---------A----------A---------A
3.  ------V---V-pause----V----------V----------V--V--pause-----V----------V----------V
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I am a bit confused.  The way you show it, there would be 3 normal Ventricle contractions before the early ventricle contraction (the PVC).  Is a PVC more than just the early contraction of the ventricle and actually the entire cycle (A-V-V)?  I always thout the PVC was only the early ventricle beat.  So trigeminy occurs on the third cycle (two complete sinus cycles followed by a cycle of A-V-V and bigeminy occurs on the second cycle (one complete normal sinus cycle followed by a cycle of A-V-V).

The reason I ask is that I have a stethascope and I will listen to what's going on when i get runs (nearly always while lying in bed).  Lately I noticed runs of A-V, A-V-V, A-V, A-V-V, A-V, A-V-V, A-V, A-V-V for like 8, 10 or so beats.  I have read that Bigeminy is possibly more dangerous than trigeminy so i am trying to figure out what these runs are.  This has only been going on for about a week.
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Hi Bill, you are correct about trigeminy, I have it drawn wrong.  I double checked with an EKG lookup.  Good catch, you understand these well!  It should be drawn like this

Trigeminy
1.  SA-------SA-------SA-------SA-------SA-------SA-------SA-------SA-------SA
2.  ---A---------A---------A----------A---------A----------A---------A----------A---------A
3.  ------V---V-pause----V----------V---V--pause-----V----------V---V--pause-----V

What you're describing here: :  A-V, A-V-V, A-V, A-V-V, A-V, A-V-V, A-V, A-V-V    I feel is bigeminy

Because you said this lasts 8 to 10 beats that would mean you're not in constant bigeminy.    I've gotten episodes like this as-well, also while lying down.  It's a bad situation, you're trying to relax and your body just won't let you.

My take on it, bigeminy episodes don't have much meaning to them per se.   It’s their frequency that deserves attention.

If one is in a constant pattern of PVCs then output of the heart will start to decrease.  Not because of the heart muscle or valves but because of the missed-timed beats.  Obviously a PVC every other beat all the time would be more concerning than every 2 beats, etc etc.  This is when PVCs cross the line into Frequent and Patterned.

Also, from what I've read and heard, folks that have frequent patterned PVCs will go 12 months or longer before they start to see any ill effects which are usually reversible once its under control.

Someone who has frequent and patterned PVCs usually respond well to ablations.  Frequent and patterned by its nature has to be coming from a single source.  Just get in there and zap it.  Whereas infrequent isolated PVC almost always are coming from various source, difficult to hit a target because it's always moving, it’s like trying to play whack-a-mole.

In other words, from my standpoint, I think you're fine.  But I'm just an anonymous amateur taking a guess on very limited info.  Your doc would be the best person to answer this concern for you.

My last point.  Put down the steth.  I've been there and done it.  When I was doing it I thought it was a perfectly normal reaction for me.  Over-monitoring oneself is a sign of being hyper vigilant and you will most definitely compound the problem with anxiety and probably some under-the-radar depression.  You probably won't even realize it.  It's there though and I really feel it can affect heart rhythm.  I’ve been there and back, I know.  If you’ve gotten an all-clear from your doctors, try to move on.
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You are right about the stethoscope.  My cardiologist told me I was fine and I need to "stay off the internet and stop taking my pulse it will only drive you crazy".  Its amazing how many people have the exact same thing.  The one common demonator (beside the PVC) is anxiety.  We all seem to be prone to anxiety which is why these bother us so much.  Both my mom and sister have them and they tell me that they don't think about them.  Considering I have had anxiety issues throughout my life, that is probably the reason I focus so much on them.  Doomsday Dan is what I call my anxiety.

Anyway, thank you so much for the advice.  Take care of yourself.
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