二段脈
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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/11/12 23:31:06」(JST)
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Pulsus bigeminus is a cardiovascular phenomenon characterized by groups of two heartbeats close together followed by a longer pause. The second pulse is weaker than the first. Look for a pattern of what appears to be a relatively normal QRS complexes, each followed by a smaller, abnormal one. The smaller beat is palpated as either a missing or an extra beat, and on EKG resembles a PVC.[1] These PVCs appearing every other beat are also called extrasystoles.
This phenomenon can be a sign of hypertrophic obstructive cardiomyopathy or of many other types of heart disease (see list below). Other causes include digitalis toxicity, induction of anesthesia,[2] placement of surgical instrumentation into the thorax or as a benign, temporary phenomenon.
In Pulsus Bigeminus not all of the conducted electrical activity will elicit sufficient ventricular contraction to produce a palpable pulse. This is important for two reasons. One, an ECG may give a ventricular contraction rate that does not correspond to the palpated pulse rate. Secondly, because not all beats are being conducted, patients may present with symptoms of low output heart failure, e.g. Dizziness, shortness of breath or hypotension, even with a normal ECG.
Management includes looking for and removing underlying cause, including medicines (such as a Calcium Channel blocker) and inotropic therapy to return cardiac output back to normal. If highly symptomatic over a longer period ablation therapy may be the only viable option.
Causes Include:
- Electrolyte imbalance e.g. Hypo or hyperkalemia
- Hypothyroidism
- Betablocker therapy
- Digoxin
- Myocardial Infarction
- Destruction or degeneration of the cardiac conduction system or heartmusclecells
- Infection
A doctor can discriminate pulsus bigeminus from pulsus alternans by auscultating the heart.
References
- ^ Anand, Nidhi; Manish Anand; Alok Vardhan Mathur; Madhukar Maletha; SK Ghildyal (2/3/2011). "Intra-operative ventricular bigeminy: Can retractor be a cause". Journal of Anesthesiology Clinical Pharmacology 26 (4): 569–570. http://www.joacp.org/article.asp?issn=0970-9185;year=2010;volume=26;issue=4;spage=569;epage=570;aulast=Anand. Retrieved 5/16/2012.
- ^ ROLLASON, WN; D. J. HALL (March 1973). "Dysrhythmias during inhalational anaesthesia for oral surgery". Anaesthesia 28 (2): 139–145. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.1973.tb00305.x/abstract. Retrieved 5/16/2012.
See also
- Pulsus bisferiens
- Dicrotic pulse
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Symptoms and signs: circulatory (R00–R03, 785)
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| Cardiovascular |
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Heart disease
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- Tachycardia/Bradycardia
- Palpitation
- Heart sounds: Heart murmur
- Systolic
- Diastolic
- Continuous
- Gallop rhythm
- Third heart sound
- Fourth heart sound
- Pericardial friction rub
- Split S2
- Heart click
- Cardiovascular chest pain
- Vascular manifestations of heart disease (pulse): Pulsus tardus et parvus
- Pulsus paradoxus
- doubled
- Pulsus bisferiens
- Dicrotic pulse
- Pulsus bigeminus
- Pulsus alternans
- Carotid bruit
- Cannon A waves
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Vascular disease
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| Myeloid/blood |
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Shock
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- Cardiogenic
- Hypovolemic
- Distributive
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Hyperaemia
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Anemia
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noco/cong/tumr, sysi/epon, injr
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proc, drug (C1A/1B/1C/1D), blte
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anat(a:h/u/t/a/l,v:h/u/t/a/l)/phys/devp/cell/prot
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noco/syva/cong/lyvd/tumr, sysi/epon, injr
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proc, drug(C2s+n/3/4/5/7/8/9)
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cell/phys (coag, heme, immu, gran), csfs
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rbmg/mogr/tumr/hist, sysi/epon, btst
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drug (B1/2/3+5+6), btst, trns
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UpToDate Contents
全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.
- 1. 動脈拍動の検討 examination of the arterial pulse
- 2. 心室性期外収縮の臨床的意義および治療 clinical significance and treatment of ventricular premature beats
- 3. 心膜疾患における奇脈 pulsus paradoxus in pericardial disease
- 4. 心タンポナーデ cardiac tamponade
- 5. 心不全が疑われる患者の評価 evaluation of the patient with suspected heart failure
English Journal
- Physical examination in ischaemic heart disease.
- Thompson PL.
- The Medical journal of Australia.Med J Aust.1976 Apr 3;1(14):492-5.
- Physical examination can yield valuable diagnostic clues in a patient suspected of ischaemic heart disease. Examination during chest pain is especially informative. The haemodynamic abnormalities which accompany angina pectoris may precipitate elevation of blood pressure, pulsus alternans, pulsus bi
- PMID 933927
- Plasma and tissue digoxin concentrations in patients undergoing cardiopulmonary bypass.
- Carruthers SG, Cleland J, Kelly JG, Lyons SM, McDevitt DG.
- British heart journal.Br Heart J.1975 Mar;37(3):313-20.
- Plasma myocardial, and skeletal muscle digoxin concentrations were measured in 32 patients undergoing cardiopulmonary bypass who were on long-term treatment with digoxin. The patients were divided into 4 groups according to the daily digoxin dose and the interval between discontinuation of the drug
- PMID 1138734
- NOTE ON THE PULSUS BIGEMINUS.
- Laslett EE.
- British medical journal.Br Med J.1909 Apr 24;1(2521):996-7.
- PMID 20764435
Related Links
- pulsus [pul´sus] (L.) pulse. pulsus alter´nans alternating pulse. pulsus bige´minus bigeminal pulse. pulsus bisfe´riens a pulse characterized by two strong systolic peaks separated by a midsystolic dip, most commonly occurring in ...
- pulsus bigeminus definition from the mondofacto online medical dictionary help contact sitemap pulsus bigeminus definition home dictionary word tools courses study skills forum about us Search dictionary help pulsus bigeminus . ...
★リンクテーブル★
[★]
- 英
- bigeminy, bigeminal pulse
- ラ
- pulsus bigeminus
- 同
- 二連脈
- 関
- 期外収縮、心室期外収縮、二連発
参考
uptodate
- 1. [charged] 心電図チュートリアル：心室性不整脈 - uptodate [1]
- 2. [charged] 心室性期外収縮の有病割合および評価 - uptodate [2]
- 3. [charged] 心室性期外収縮の臨床的意義および治療 - uptodate [3]