Premature ventricular contractions are common in the general population and are often seen during general anaesthesia. A high frequency of premature ventricular contractions may be associated with underlying left ventricular dysfunction. Premature ventricular contraction-induced cardiomyopathy is a rare disease and requires cardiologist input into peri-operative management. Medical and interventional management strategies may completely reverse the disease process. A 19-year-old man was scheduled for removal of tibial metalwork, due to chronic pain, and ventricular bigeminy was noted in the anaesthetic room before induction of anaesthesia. Surgery was postponed and he was later diagnosed with premature ventricular contraction-induced cardiomyopathy. Ventricular bigeminy noted before induction of anaesthesia may not always be benign.