Trigeminy

Trigeminy is irregular heart beat or arrhythmia comprising of a repetitive series of 2 normal heart beats and 1 premature beat. With regards to ECG activity readings, trigeminy refers to a rhythm wherein every third heart beat is ectopic, i.e. starting from some other area and not the sinus node. Without qualification, trigeminy often means trigeminal PVCs, though it can occasionally also refer to trigeminal premature junctional contractions/PJCs or trigeminal premature atrial contractions/PACs

PVCs refer to early depolarizations commencing in the ventricle instead of the sinus node. Ventriculartrigeminy is defined as the occurrence of a PVC every third beat. A high frequency of trigeminy PVCs in heart disease patients has been found to cause ventricular fibrillation and unexpected death. This is not an indication that all affected individuals are prone to sudden death.

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Symptoms of trigeminy PVC

The signs and symptoms of trigeminy PVCs are the same that appear with other kinds of arrhythmias, including:

  • Lightheadedness
  • Palpitations
  • Faintingor passing out
  • Shortnessof breath
  • Painin chest

Causes

Some cases of trigeminy PVCs are just ‘normal variants’ which may occur in normal healthy persons. Other causes of trigeminy PVC are listed below:

  • Abnormal quantities of minerals or electrolytes in the bloodstream. Low levels of magnesium and/or potassium are the usual anomalies associated with electrolytes. It may arise due to varied causes, including the use of water pills or diuretics.
  • Underlying presence of different kinds of heart diseases such as cardiomyopathy, coronary artery disease, and mitral valve prolapse, etc.
  • Trigeminy ventricular arrhythmias may also occur due to familial or congenital causes.
  • The condition often deteriorates with elevated stress levels, or decreased sleep.
  • Severe trigeminy ventricular arrhythmia can be caused due to cocaine use.
  • Other causes include exposure to toxins, including alcohol abuse; overuse of stimulants like nicotine and caffeine; abnormal thyroid levels; inflammation, infection, or degeneration of the cardiac muscle; intake of certain natural/herbal formulations and OTC drugs that contain essential stimulants; and infections affecting areas of the body other than the heart.

Treatment of trigeminy PVC

The usual treatment of trigeminy PVC includes the following:

  • Remedying any and all underlying health problems like thyroid disorders, imbalances in electrolyte levels, etc.
  • Proper treatment of pre-existing cardiac disorders.
  • Avoiding the intake of medications or stimulants which can aggravate the condition.
  • Engaging in a relevant exercise regimen.
  • Getting sufficient sleep and removal of factors that cause increased stress.

In case trigeminy PVC persists, then doctors may opt for the following:

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  • In certain cases, doctors may prescribe other/new kinds of drugs.
  • For patients with severe heart problems and increased risk to sudden death, a cardiologist may recommend the use of medical devices such as defibrillators or implantable cardioverters.
  • Some individuals with serious trigeminy PVC may experience alleviation of symptoms via use of procedures that involve removal or destruction of a part of cardiac tissue.

Medical treatment of trigeminy PVC: It includes the use of prescription medications, carrying out different kinds of surgeries, and use of pacemakers or other implantable devices.

  • Medications
    • Anti-arrhythmic medicines:Certain types of anti-arrhythmic drugs tend to lower the number of trigeminy PVCs by changing the electrical properties of the heart muscle. It may however be noted that each of these drugs also come with the potential to worsen the cardiac rhythm, which can be really serious at times.Clinical trials of a lot of such drugs used in certain groups of people with trigeminy ventricular arrhythmias to lower the mortality rate, actually led to increased mortality. Hence, such drugs are given to only select patients and their health is monitored 24/7.
    • Beta-blockers: Research indicates that different types of beta blockers not only help alleviate the symptoms of trigeminy PVCs, but also lower the vulnerability to sudden death in patients with high risk. Beta blockers are very effective in resolving trigeminy PVC related palpitations. They however can result in side effects due to which doctors may discontinue its use thereafter.
    • Surgery
    • Some individuals tend to have a comparatively small quantity of cardiac tissue which is often the main cause of severe trigeminy ventricular arrhythmias commencement and persistence. In such patients, specialists may treat the condition by destroying or eliminating this section of the heart muscle.
    • PacemakersPacemakers are used to prevent excessively slow heart beats. As trigeminy PVCs refer to rapid heartbeats, pacemaker therapy is generally not recommended as a treatment option.However, in some patients trigeminy ventricular arrhythmias may occur because of an excessively slow heart rhythm. In such instances, doctors may suggest the use of a pacemaker.

      Other medical devices

      Automatic Implantable Cardioverter-Defibrillators or AICDs are similar to pacemakers, but work by delivering an electrical discharge or a ‘shock’ so as to interrupt severe trigeminy ventricular arrhythmias. They are great for treating serious cases of PVCs, but are not used for patients with mild or occasional trigeminy.

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