Spiral waves are a well-known and intensively studied dynamic phenomenon in excitable media of various types. Most studies have considered an excitable medium with a single stable resting state. However, spiral waves can be maintained in an excitable medium with bistability. Our calculations, performed using the widely used Barkley model, clearly show that spiral waves in the bistability region exhibit unique properties. For example, a spiral wave can either rotate around a core that is in an unexcited state, or the tip of the spiral wave describes a circular trajectory located inside an excited region. The boundaries of the parameter regions with positive and ‘negative’ cores have been defined numerically and analytically evaluated. It is also shown that the creation of a positive or ‘negative’ core may depend on the initial conditions, which leads to hysteresis of spiral waves. In addition, the influence of gradient flow on the dynamics of the spiral wave, which is related to the tension of the scroll wave filaments in a three-dimensional medium, is studied.