What Is Bigeminy?

Medically Reviewed by James Beckerman, MD, FACC on November 07, 2022

If you have bigeminy (bi-JEM-uh-nee), your heart doesn't beat in a normal pattern. After every routine beat, you have a beat that comes too early, or what's known as a premature ventricular contraction (PVC).

PVCs are common and not always harmful. If you're in good health, you may not even need treatment. But if you have a heart condition, you may need to take medicine to control your bigeminy. Lifestyle changes can also keep this abnormal heart rhythm from getting worse.


PVCs are extra electrical impulses. They start in one of your heart's two lower chambers. You'll hear your doctor refer to it as "ventricular."

Some people say it feels like their heart skips a beat or flutters. Others describe PVCs as their heart working too hard or beating too fast. But you may not notice anything at all. Many people don't know they have bigeminy until the abnormal rhythm shows up on a heart test called an electrocardiogram (EKG).


Many different things can bring on bigeminy. They include:

  • Your family history
  • An infection in your heart, or somewhere else in your body
  • Things that rev up your heart: caffeine, nicotine, drugs like cocaine, and some over-the-counter or herbal medicines
  • Too many or too few electrolytes (minerals like potassium and sodium) in your blood
  • Thyroid disease

Some heart conditions can also lead to bigeminy. Coronary artery disease, in which a wax-like plaque builds up in your arteries and blocks blood flow to your heart, can upset your ticker's rhythm. So can cardiomyopathy, a disease that causes your heart muscle to become enlarged or thickened.


Your doctor will want to find out if another health issue is causing your bigeminy. They may order tests that check your electrolyte levels and how well your thyroid is working.

You may also be asked to have a Holter monitor test or echocardiogram (your doctor might call this an echo). Both of these tests are used to gather more information about how your heart is acting. For a Holter test, you'll wear a small device, usually for a day or two. It keeps track of your heart's rhythms. The echo uses high-frequency sound waves to take a picture of your heart. It's sometimes called a cardiac ultrasound.

Your doctor may also want you to take an exercise stress test. This will help them see if physical activity makes your bigeminy worse. During the test, you'll ride a bike or run on a treadmill while the doctor tracks your heart rhythm and blood pressure.


Your doctor will address any issue, such as an electrolyte imbalance or overactive thyroid, that could be causing the bigeminy. But if you don't have any symptoms and your heart is working as it should, you may not need treatment.

Still, some lifestyle changes can prevent your PVCs from getting worse or more frequent. Since anxiety can cause your heartbeat to speed up or be abnormal, find a way to reduce your stress. Try daily exercise, meditation, or yoga, or talk about your feelings with someone you trust. Get enough sleep so your body stays strong. You'll also want to avoid caffeine, alcohol, smoking, and recreational drugs, since these can all make PVCs more severe. It might help to track your symptoms in a journal so you can spot other triggers.

If you feel dizzy, are short of breath, or have chest pain, your doctor may want you to take beta blockers (beta-adrenergic blocking agents). This type of drug lowers your blood pressure and causes your heart to beat more slowly. These drugs are often prescribed for arrhythmias and are safe. Calcium channel blockers or anti-arrhythmic drugs such as amiodarone (Cordarone, Pacerone) or flecainide (Tambocor) are other drugs your doctor might prescribe.

If your bigeminy is having a severe effect on your heart, you could need cardiac ablation. For this, your doctor will give you medication to "put you under." While you're sedated, the doctor will insert a long, stretchy tube called a catheter into a vein in your groin, then thread it up to your heart. The doctor will then use heat, a laser, or extreme cold sent through the tube to destroy the tissue causing your abnormal heartbeat. This procedure is done in the hospital, but you may be able to go home the same day.

Show Sources


American Heart Association: "Echocardiogram - Echo."

Cardiac Health: "Bigemini," "Premature Ventricular Contractions," "What Are the Causes of Ventricular Arrhythmias, VT, Bigeminy, and Trigeminy?"

Hebbar, K.A. American Family Physician, June 15, 2002.

Mayo Clinic: "Premature Ventricular Contractions," "Holter Monitor," "High blood pressure (hypertension): Beta Blockers," "Cardiac Ablation," "Test and Procedures: Implantable cardioverter-defibrillators (ICDs)," "Stress Test."

National Heart, Lung, and Blood Institute: "What Is Cardiomyopathy?" "What is Coronary Heart Disease?"

University of Arizona Sarver Heart Center: "Clinical Approach to Patients with Frequent PVCs."

Richard Wright, MD, chairman, Pacific Heart Institute, Providence Saint John's Health Center, Santa Monica, Calif.

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