Atrial Bigeminy

Health Professional

I was recently diagnosed with atrial bigeminy. Could you tell me what it is and a little bit about its symptoms? How do I know I need to see a doctor for an emergency?

Atrial bigeminy is actually a description of a pattern of heart beats that occurrs in couplets. A regular (or sinus) beat is followed by a "premature" atrial beat. These premature beats are the result of electrical impulses sent from other parts of the atrium than the sinus node (our normal pacemaker). Such "extra" or "premature" beats cause more problems for doctors than patients. In reality, they are almost never felt unless we take our own pulse or blood pressure. For the health care worker or patient who takes a blood pressure, premature atrial beats or runs of atrial bigeminy make it difficult to get a good reading. The premature beat has a lower blood pressure as the heart hasn't had sufficient time to fill with blood. As the normal beat may have a higher pressure, the measurement with a blood pressure cuff becomes a bit more difficult. Actually, atrial bigeminy is very rarely a long-term rhythm, and minutes to hours later, the "premature" beats are often markedly decreased or gone. Most of the time, the premature beats go away just by changing what you are doing (like getting up to walk around).

Because premature beats are out of phase with the normal pulse, they are often felt to be "extra beats". Unless they are causing you problems, they don't deserve your attention. This gets us to the questions that  was originally asked. There are no symptoms from atrial bigeminy. Rare patients will note that their pulse is irregular.

If a patient develops rapid heart rates that do not seem appropriate for the level of work being done,  it may be due to the development of a different rhythm, such as atrial fibrillation or flutter. These rhythms are felt as episodes of heart racing as if you are doing something strenuous, but in the absence of any apparent trigger. We call these episodes "palpitations". If such an episode occurs, it would be appropriate to take your pulse noting whether the rate is fast or slow, regular (like the ticking of a clock), or irregular. The things that a doctor will want to know are: heart rate, regularity, frequency, duration, and accompaniment. If palpitations last more than 30 minutes, are becoming more frequent, or are accompanied by loss of consciousness, feeling faint, breathlessness, chest, jaw, shoulder or arm pain it would be considered appropriate to consider getting medical care immediately.

Some people get extra beats because of certain outside stimuli. The most common such stimuli are cigarettes, alcohol, coffee, tea, and cola drinks.   The cause of extra beats can also be related to a patient's sensitivity to drugs that are often available over-the-counter or suggested for your use by physicians, especially those used for the symptoms of colds, asthma and flu. The worst offenders among drugs are the ones that physicians do not recommend: ephedrine and ma huang and other unregulated "products and teas" promoted to help lose weight or stimulate learning or attention; and stimulating drugs such as cocaine or some of the "designer" drugs. These latter cause the most problems due to denial (it is fascinating to watch this process at work, first there is denial of use, then there is denial that there could be a relationship. I will address this in another column).