Can Strep Throat Cause Bigeminy?
No, strep throat does not cause bigeminy. There is no established connection between streptococcal pharyngitis and cardiac arrhythmias such as bigeminy in the medical literature or clinical guidelines.
Why This Question Arises
The confusion likely stems from the well-documented cardiac complications of untreated streptococcal pharyngitis, specifically acute rheumatic fever, which can lead to rheumatic heart disease 1. However, these complications involve valvular damage and inflammatory carditis—not primary arrhythmias like bigeminy.
Established Cardiac Complications of Strep Throat
Rheumatic Fever (Not Arrhythmia)
- Acute rheumatic fever is the primary cardiac complication of untreated Group A streptococcal pharyngitis, occurring in approximately 3% of untreated cases during epidemics (much lower in endemic situations) 1
- Rheumatic fever causes inflammatory carditis and valvular damage, not primary electrical conduction abnormalities 1
- Appropriate antibiotic treatment prevents acute rheumatic fever in most cases 1
Non-Cardiac Complications
The documented complications of streptococcal pharyngitis include 1:
- Suppurative complications: peritonsillar abscess (quinsy), acute otitis media, cervical lymphadenitis, mastoiditis, acute sinusitis
- Non-suppurative complications: acute rheumatic fever, post-streptococcal glomerulonephritis
- Rare severe complications: pulmonary-renal syndrome (extremely rare, only six documented cases) 2
What Bigeminy Actually Represents
Bigeminy is a primary electrical rhythm disturbance characterized by alternating normal beats and premature ventricular or atrial contractions. Common causes include:
- Electrolyte abnormalities
- Myocardial ischemia
- Structural heart disease
- Medication effects
- Stimulant use
Clinical Pitfall to Avoid
Do not attribute bigeminy to strep throat. If a patient presents with both pharyngitis and bigeminy:
- Treat the streptococcal pharyngitis appropriately with penicillin or amoxicillin for 10 days 3, 4
- Evaluate the bigeminy as a separate clinical entity with standard cardiac workup (electrolytes, ECG, cardiac history, medication review)
- Consider that the bigeminy may be coincidental or related to systemic illness (fever, dehydration) rather than the streptococcal infection itself
When to Worry About Cardiac Involvement
Patients at increased risk for complications from strep throat include those with 1:
- History of rheumatic fever (highest risk for recurrence)
- History of valvular heart disease
- Immunosuppression
These patients require aggressive treatment of streptococcal pharyngitis, but again, the concern is rheumatic fever and valvular disease—not arrhythmias 1.