Hello! Thank you for asking on HCM! Regarding your concern, I would explain that first of all it is important to differentiate pulsus bigeminus form pulsus alternans by cardiac auscultation, as there is a lot of confusion between them. It may be a sign of hypertrophic obstructive csrdiomyopathy, or other disorders, like possible effect of beta-blocker use, dyskalemia, hypothyroidism, disorders of the cardiac conductance system, etc. I recommend you to don t panic! As long as you are free of any disturbing symptomatology, and do not exert clnical signs and symptoms of heart failure, you don t have to worry too much! Probably we have to do only with some extrasystoles without any clinical significance. Nevertheless, I recommend you to consult your cardiologist for a careful physical examination (including cardiac ousculatation), and a comprehesive review of your cardiac condition, to rule out any possible underlying factors. Hope to have been helpful to you! Greetings! Dr. Iliri