Ventricular bigeminy (PVCs in bigeminy) on ECG for new nurses and students
The pattern above depicts ventricular bigeminy. Every second beat is a PVC (premature ventricular complex).
In ventricular trigeminy every third beat is a PVC. In ventricular quadrigeminy every fourth beat is a PVC. Easy! Right?
On the ECG:
HR: variable and based on the underlying rhythm
Rhythm: irregular due to premature interruptions
P waves: based on underlying (may distort PVC if buried within)
QRS: wide at site of PVC
We can also address the underlying rhythm. The PVCs are an interruption in the underlying rhythm which is sinus in origin above. And so, we would describe the underlying rhythm first (i.e. sinus rhythm/bradycardia, etc.) followed by the PVC grouping or pattern present (i.e. sinus rhythm with PVCs in bigeminy; or sinus rhythm with a ventricular couplet if couplets were present). Check out the graphic below for more information.
Ventricular ectopy that is increasing in frequency may represent ischemic changes or an unhappy heart although electrolyte imbalance, stimulant use, drug toxicities and more may also contribute.
For rhythm recognition practice and more follow @thevisualnurse on Instagram!
===================
Instagram @thevisualnurse
TikTok @the.visualnurse
