Bigeminia is a definite form of arrhythmia, characterized by premature heart excitations (extrasystoles) that appear after every normal heartbeat. Thus, sinus and extrasystolic cycles alternate in a 1: 1 ratio. At the same time, an equal interval of cohesion is noted. As a rule, under such an arrhythmia as bigemini, doctors mean a ventricular or supraventricular (supraventricular) extrasystole. In this case, premature heart excitement is an extraordinary cardiac contraction, which can be fixed on the ECG.
Extrasystoles of a healthy person make up almost 55 cuts per hour. In those moments when the extrasystole is characterized by alternation of normal contractions with extraordinary contractions, especially if it is recorded on an electrocardiogram very often, it is considered the formation of bigeminy.
In addition, for this type of allorhythm it is very difficult to determine its prognostic value without Holter monitoring or within 24 hours, since bigeminy can appear or disappear for twenty-four hours. If this condition lasts throughout the day only for five to ten minutes, then this is more or less tolerable, but with such an arrhythmia for several hours, you can consider this cardiac contraction as a pathology.
This form of arrhythmia is characterized by the correct alternation of a single normally occurring complex with one ventricular extrasystole, which is a kind of allorhythmia. At the same time, premature excitation from the right side of the heart, that is, from the ventricle, is noted. Nadzheludochkovaya bigeminia is a correctly alternating one rhythmic cardiac contraction and one extrasystole.
Very often, digitalis intoxication is manifested by such symptoms as ventricular bigeminy. In addition, ventricular extrasystoles appear or increase at the time of therapeutic treatment with glycosides as a result of an overdose of these drugs or sensitivity to their toxic effects.
Ventricular bigemia, especially in the group or polytopic form of extrasystoles, indicates a pronounced process of intoxication after the use of digitalis preparations. As a rule, this presents a danger in their transition to ventricular fibrillation.
Quite often this kind of arrhythmia develops in patients with diseases of SS. when appointing Novokainamid, Adrenaline, Novocain, Quinidine. In addition, ventricular bigeminy can be formed after the application of certain types of anesthesia, such as Cyclopropane, Chloroform, etc. In some cases, this pathological condition develops as a consequence of treatment by electrical impulses or as a result of the application of electrostimulation of the heart. Also, the post-conversion period is very often characterized by atrial and ventricular extrasystoles, VT paroxysms, etc., which develop as a result of the damaging effect of the current.
The causes of development of ventricular bigeminy can be heavy poisoning with organophosphorus substances during acute intoxication, as well as various violations of electrolyte balance in the myocardium, surgical interventions on the heart, sounding of the heart cavities, coronagraphy and other reasons.
The symptomatic picture of ventricular bigemini can occur without sensation of arrhythmia, although sometimes it is determined by the irregular pulse or irregular heartbeat. In this case, there is a weak heart beat, followed by a slightly stronger blow. In some cases, patients do not feel this strong blow, and then it seems that the pulse is very weak filling, but in fact the heart beat remains normal and is 60-80 beats per minute. As a rule, such a condition, in the form of imaginary bradycardia , is not always possible to sense on the pulse of peripheral vessels.
The reasons bigemy
The formation of this form of arrhythmia is directly influenced by the vegetative and central nervous system.
At the heart of all reasons for the emergence of bigeminy lie changes in the heart muscle of organic origin. It is also important to take into account that even the smallest disturbances in the myocardium with accompanying factors of a functional nature, especially with the effects of the nerves of extracardiac genesis, can lead to the appearance of an ectopic focus of excitation.
In addition, against the background of various forms of coronary artery disease, the cause of bigeminy can be changes in the heart muscle or organic heart disorders when joining functional provoking factors. For example, bigemia is noted in 80% of patients with infarction, and one of the most frequent violations of this rhythm is ventricular bigeminy. And sometimes such extrasystoles lead to early manifestations of insufficient functioning of coronary vessels. Often, ventricular bigeminy provokes the development of an attack of angina pectoris . It has also been proven that often such forms of arrhythmia, especially after a heart attack, cause a poor prognosis, because the risk of a sudden fatal outcome as a result of VF is significantly increased.
Bigeminia is also found in patients with acquired rheumatic heart defects, especially aortic stenosis and prolapse of the mitral valve . But the main reason for the emergence of bigeminy of organic genesis in the younger generation is the presence of rheumatism.
For bigeminy characterized by such subjective symptoms as a sense of impact in the heart, interruptions or cardiac arrest for a short period of time. Quite rarely this pathological condition is manifested by cardialgia or stenocardial pains, sensation of a thrust, some compression and very strong filling in the neck area.
Brain symptomatology is characterized by the appearance of attacks of faintness, fainting, aphasia and twisting of the head in a patient with a pathological condition of bigemia. Among the rare symptoms is the transient form of hemiparesis.
Signs of a general vegetative and neurotic character are the pallor that appears in the patient, adynamia, nausea, severe sweating, a sense of fear, lack of air and some excitement.
As a rule, when there is bigeminy, as well as often appearing premature heart excitements, the heart begins to beat briefly in the patients, it seems to be compressed, and the strokes of the dull character or the flutter of the heart are felt. But the appearance of pain in the heart is very rare. But if they arise, they manifest themselves with short pains of the perforating property or with undefined soreness, which is caused by the irritations of the interoceptors as a result of the overfilled ventricles at the moment of a pause after premature cardiac excitation and the next vigorous contraction of the heart. Characteristic such sensations are also influenced by abrupt processes of atrial expansion as a result of the fact that at that moment all chambers of the heart are contracted almost simultaneously. Such a pain in the heart very often resembles the pain of neurotic origin.
Sometimes bigemia causes a decrease in blood circulation in the coronary vessels, especially in coronary atherosclerosis , so it can manifest quite resembling the symptoms of typical angina. In addition, at the same time, a wave is felt from the heart to the neck or head region, which coincides with the extrasystole.
Sometimes bigeminy is characterized by the appearance of dizziness and nausea as a result of reduced blood supply to the brain against a background of frequent extrasystoles. As a rule, the symptomatology of bigeminy is considered an expression of disorders of the autonomic nervous system.
On ECG, bigemia is an alternation of linked intervals and post-extrasysiological cardio intervals, which are determined on the rhythmogram by alternating elongated and shortened intervals (RR). Bigemini on the scattergram, which continues throughout the recording period, is identified by two points in the aggregate. And episodes of bigeminy are characterized by another type of record.
Basically, bigeminia does not need a special treatment. To begin with, it is sufficient to eliminate the provoking factors of psychological and emotional origin, as well as chronic foci of infection.
But in order to make a decision in determining the tactics of drug therapy pay attention to the tolerability of this pathological condition, the amount of premature cardiac excitation during the day, the characteristics of extrasystoles, the presence of cardiac pathology and other forms of arrhythmia, since bigemnia is not an independent disease.
As a rule, after finding out all the reasons for the appearance of bigeminy, they begin to treat the underlying disease. As a result of arrhythmia of neurogenic genesis, sedative or sedative remedies are prescribed, as well as a consultation of a neurologist. When poisoning with medicamental agents, the emerging bigemia is treated with the cancellation of these drugs.
In the presence of cardiac pathology, antiarrhythmic drugs may be prescribed after an individual examination with the help of Holter monitoring. In this case, such drugs as Sotalol, Cordarone, Lidocaine, Novocainamide, Quinidine, Diltiazem and others can be prescribed.