Differential Diagnosis for New Ventricular Bigeminy
- Single most likely diagnosis:
- Myocardial ischemia or infarction: This is often a cause of ventricular bigeminy due to irritation of the ventricular myocardium or conduction system, leading to premature ventricular contractions (PVCs) alternating with normal beats.
- Other Likely diagnoses:
- Electrolyte imbalance: Abnormal levels of potassium, magnesium, or calcium can affect cardiac conduction and lead to ventricular bigeminy.
- Cardiomyopathy: Conditions like dilated cardiomyopathy can lead to ventricular arrhythmias, including bigeminy, due to structural heart disease.
- Valvular heart disease: Significant valvular disease can lead to ventricular arrhythmias, including bigeminy, due to increased stress on the ventricles.
- Do Not Miss diagnoses:
- Acute myocardial infarction with reperfusion: Although potentially included under myocardial ischemia, it's crucial to identify this condition due to its urgent need for intervention.
- Cardiac tamponade: Although less common, cardiac tamponade can lead to arrhythmias, including ventricular bigeminy, and is a medical emergency.
- Pulmonary embolism: A large pulmonary embolism can cause right ventricular strain, leading to arrhythmias, and is a condition that requires immediate attention.
- Rare diagnoses:
- Arrhythmogenic right ventricular cardiomyopathy (ARVC): A rare condition characterized by replacement of the right ventricular myocardium by fatty tissue, leading to arrhythmias.
- Catecholaminergic polymorphic ventricular tachycardia (CPVT): A rare genetic disorder that can cause ventricular arrhythmias, including bigeminy, often triggered by physical activity or emotional stress.
- Sarcoidosis: A systemic granulomatous disease that can affect the heart, leading to arrhythmias, including ventricular bigeminy, due to granulomatous infiltration of the myocardium.