Pulse deficits resulting in apparent bradycardia in atrial bigeminy

Supraventricular premature beats are premature activations of the atria outside of the sinus node that is often benign. They typically present with irregular pulses and dynamic changes to pre-existing murmurs between sinus beats and ectopic beats, but rarely with bradycardia. We describe an elderly male with atrial bigeminy who presented for evacuation of a soft tissue collection in a regional hospital. On examination, he appeared bradycardic due to a significant pulse deficit, despite remaining haemodynamically stable and asymptomatic. This led to two emergency response teams being called and a brief admission to coronary care unit (CCU), primarily due to the ward's limited access to telemetry, before he underwent an uneventful surgery and was discharged. This case highlights the logistical challenges of monitoring such patients where telemetry is not readily available and emphasises the importance of recognising pulse deficits as a cause of peripheral bradycardia in otherwise stable patients with supraventricular ectopic beats.