My last two shifts have included patient's with bigeminal premature ventricular contractions (PVC). Bigeminy is a condition where every other beat does not come from the primary pacemaker. In both cases my patients had sinus rhythm with bigeminal PVCs. One of the patient's had multifocal PVCs. The other had unifocal PVCs during the bigeminy, but had multifocal couplet PVCs later (I unfortunately did not get a strip with that). As you can imagine, those are some sick hearts.
My concern would be if the rate of perfusing beats is not high enough to support hemodynamics. Surprisingly, even though neither patient's PVCs were perfusing they were both stable with these rhythms, even though the perfusing rate was quite bradycardic. One of these was the patient's normal rhythm, and thankfully I was made aware of this before I treated a problem that did not exist!
60yo F C/C Abdominal Pain
55yo M C/B SOB w/ exertion