what can you tell me about bigeminal rhythms?

Nurses General Nursing


  • Specializes in Preoperative and PACU; Med/Surg; ED; Home Health.

My understanding is that they're benign and it's a premature beat next to the QRS complex.

I will never understand telemetry and rhythms.

In 95 when I was in my senior year of nursing school, I took the Critical Care course and we studied the strips but it was so confusing to me. The instructors told me that I'd learn more by actually doing it in my job. Well then I worked Oncology and our tele patients were monitored by the tele nurses on another unit. They called our charge nurse who then told me what needed to happen. I just never learned a lot about strips.

Then we had three kids and I've been home with them and recently went back to work per diem as a registry RN where we have more minor illness/etc to care for.

Any suggestions? I've pondered going to work for a larger hospital which offers a great orientation and actual CLASSES (Classes Offered: Cardiovascular system, Respiratory, Neurological/Surgical, Renal, and Hemodynamics). But I presently only work 1-2 times every week or so. And it may only be for a 4.5 hour shift to help out. THis is good b/c we have little girls that I want to stay home with as much as possible.

I'm rambling. Any help with the bigeminy though?

Tweety, BSN, RN

33,494 Posts

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Telemetry is a tough skill. I've taken tele courses three times. Seems every three or four years I need to brush up. I currently am working on a tele unit and get more exposure. But still have to sit and think methodically each rhythm I want to interpret.

About bigeminy, it can be serious or it can be benign. It definately requires further investigation. I had a coworker who was in chronic bygeminy at the age of 45 and needed to have an ablation. Other patients I've had in bigemy that were asymptomatic and nothing needed to be done. Sometimes a patient in bigemy is hypoxic, sometimes their electrolytes are out of wack, all kinds of things can underly the cause. The trick is finding what that is.

Good luck! :)


29 Posts

Hi MargRN,

Tweety's absolutely right about the bigeminy--you have to look at the rest of the clinical picture to figure out if it's benign or about to be lethal. As far as getting more comfortable with rhythms, maybe this larger hospital you're looking at has a Basic Arrhythmias course. These start out very, very basic and give you the building blocks on how to read rhythms--sort of like crawling before you walk :chuckle . I have to brush up on my advanced arrhythmias from time to time, but that basic class has held up for me for years. It sounds as this new hospital may be fairly proactive re education--I'll bet they have a course or know where you can get one! Good luck!


1,170 Posts

I am assuming you are referring to bigeminal PVC's. I have had pt with bigeminal PAC's too. Both can be benign or not. You got to look at the pt.

I am worked tele for over 15 years. For a several years an RN used to sit at the monitors on the 3 days a week the tele monitor was off.( not anymore, tele tech 7 days a week) This is where I really picked up my rhythms. Also patients don't have perfect textbook rhythms like you see in EKG courses or texts. They move and there is artifact and sometime funky rhythms. An example is the patients that has atrial fib mixed with some sinus beats and some PAC's. This is called chaotic atrial rhythm it is a mess and very hard for someone new to rhythms. to figure out. This is seen most often in patients with COPD.

Remember that even if the monitors are on another floor you are still responsible for the patient. Get strips from your patients each night and analyze them and have someone experienced check them. The patients nurse should be doing this anyways.

I feel the same way about 12 lead EKG's that you do about tele monitoring. I have taken classes but if I don't use it I lose it. Big tombstone changes on the EKG are obvious but it is the other more subtle things that are harder to learn.

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