Pulsus bigeminus

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Moubarak, M.D. [2]


Pulsus bigeminus is a cardiovascular phenomenon, in which two heartbeats occur close to each other followed by a long pause. The second pulse is weaker than the first, and it is caused by premature contractions after every other beat, usually of the ventricles.



Pulsus bigeminus may be innocent and a temporary phenomenon, but mostly seen in cases of hypertrophic obstructive cardiomyopathy.

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Pulsus bigeminus in itself is not a life threatening condition.

Common Causes

The most common cause of pulsus bigeminus is hypertrophic obstructive cardiomyopathy, other causes include:

Causes by Organ System

Cardiovascular Hypertrophic obstructive cardiomyopathy, myocardial infarction
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug and Toxin Side Effect Beta blocker, calcium channel blocker, digoxin
Ear Nose Throat No underlying causes
Endocrine Hypothyroidism
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic [No underlying causes
Hematologic No underlying causes
Iatrogenic No underlying cause
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic No underlying cause
Nutritional / Metabolic No underlying cause
Obstetric/Gynecologic No underlying cause
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity [No underlying causes
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal / Electrolyte Hyperkalemia
Rheum / Immune / Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order