While the heart does not literally skip a beat, it may feel that way. The reason is that the heart’s rhythm has become irregular and the movement of blood through it is different to what a person expects.
Most people will experience bigeminy at some point in their lives, and, mostly, it is not a cause for concern.
Learning more about bigeminy can help people understand their symptoms and understand when they may need to seek medical care.
The cause of bigeminy may not always be clear, since there are many possible causes.
Palpitations that occur with bigeminy can have many causes, and it may not be possible to identify the cause.
One study of people treated for palpitations at a university medical center found:
- 40 percent were caused by arrhythmia
- 31 percent were due to anxiety or panic disorders
- 16 percent had no identifiable causes
- 6 percent were due to prescription, over-the-counter, or illegal drugs
- 4 percent had non-cardiac causes
- 3 percent had a cardiac cause other than arrhythmia
Experts might not always be able to say what causes each case of bigeminy, but the condition is linked to changes in the heart’s rhythm sparked by variations in the its electrical system.
Even though it is only the size of a fist, the human heart is an incredible rhythm machine. It beats 100,000 times a day and moves roughly 5 liters of blood throughout the body, a distance of almost 60,000 miles.
It does all this thanks to a rhythmic cycle of contraction and relaxation, which pumps blood through the four chambers of the heart.
This process is triggered by electrical impulses occurring 60–100 times a minute in a resting, healthy adult.
The characteristic sound of the heartbeat – lub-DUB, lub-DUB, lub-DUB – comes from the valves between the chambers opening and closing, as the blood circulates through the heart.
When the timing gets skewed, the rhythm gets skewed. The technical term for this is an arrhythmia, and there are many forms of it, including bigeminy.
When bigeminy happens, it may feel as if the heart is skipping a beat or having palpitations. These unusual, early beats are also called ectopic contractions.
An individual may feel as if there is a pause between the beats of their heart.
It may feel like the heart is skipping a beat, but bigeminy is a kind of arrhythmia in which the heart beats too early, or prematurely.
If heart palpitations are accompanied by feeling faint, actually fainting, or dizziness, individuals should seek prompt medical care.
Diagnosis and when to see a doctor
To diagnose bigeminy, a doctor may enquire about a person’s stress levels and health conditions.
If bigeminy lasts for a long time, recurs, or someone has a personal or family history of heart disease, it is advisable to see a doctor to be diagnosed.
Doctors will ask someone about:
- symptoms in their chest, such as palpitations
- incidents of dizziness
- heart issues, such as high blood pressure or previous arrhythmia
- thyroid problems
- personal stress levels
- exercise habits
- use of tobacco
- prescription drug use
- use of supplements and over-the-counter drugs
- consumption of caffeine and alcohol
- use of cocaine and other illicit drugs
Doctors ask about these issues because they can all affect heart health. As heart problems may have a genetic link, doctors will also most likely take a detailed family health history.
A physical exam is important to diagnosing bigeminy, with doctors taking a close look at the condition of the heart. The first steps for this process involve:
- taking pulse and blood pressure readings
- listening to the heart rate and rhythm
- checking for a heart murmur
- looking for signs of heart failure, such as edema or swelling
- checking thyroid health, and other possible causes of arrhythmia
The best way to examine the health of the heart’s rhythm section is with an electrocardiogram, also known as an ECG or EKG.
An ECG measures the timing and the level of the electrical waves passing through the heart and stimulating the different chambers to contract and relax.
Treatment and lifestyle changes
Avoiding coffee, tea, and other drinks containing caffeine may help to treat bigeminy.
Bigeminy will not usually require complicated treatment and will frequently resolve on its own.
Medical experts have identified several substances as potential triggers for episodes of bigeminy. Limiting or avoiding intake of these can make it easier for the heart to keep a steady beat.
Potential substances and triggers to avoid include:
- caffeine in coffee, tea, energy drinks, and some soft drinks
- medications for seasonal allergies, asthma, and colds
High blood pressure may increase the likelihood of palpitations, which gives individuals with hypertension more reason to carefully manage their blood pressure.
Exercise may sometimes trigger episodes of bigeminy, so individuals who have had palpitations should use caution when starting or returning to fitness activities.
Doctors may prescribe drugs known as beta-blockers when bigeminy episodes are frequent and potentially serious.
In the rare cases of bigeminy that require more aggressive treatment, a surgical process known as catheter ablation may be used to treat heart tissue.
In most cases, when otherwise healthy people experience bigeminy, the symptoms go away on their own, and there is no need for treatment.
However, if episodes of bigeminy are frequent and severe, particularly if they are accompanied by dizziness and feeling faint, people should see a doctor for a thorough evaluation and treatment plan.
For those who already know they have heart disease, frequent episodes of bigeminy could be a sign that they are at increased risk for serious heart problems. These people should see their doctor to discuss adapting their treatment plans.
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