Holter monitoring


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Holter Monitoring

 

Definition

Holter monitoring is continuous monitoring of the electrical activity of a patient's heart muscle (electrocardiography) for 24 hours, using a special portable device called a Holter monitor. Patients wear the Holter monitor while carrying out their usual daily activities.

Purpose

Holter monitoring is used to help determine whether someone has an otherwise undetected heart disease, such as abnormal heart rhythm (cardiac arrhythmia), or inadequate blood flow through the heart. Specifically, it can detect abnormal electrical activity in the heart that may occur randomly or only under certain circumstances, such as during sleep or periods of physical activity or stress, which may or may not be picked up by standard, short-term electrocardiography performed in a doctor's office.
Traditionally, an exercise stress test has been used to screen people for "silent" heart disease (heart disease with none of the usual symptoms). However, an exercise stress test is not completely foolproof, often producing false negative results (indicating no heart disease when heart disease is actually present) and false positives (indicating heart disease when there is none). Furthermore, some people cannot undergo exercise stress testing because of other medical conditions, such as arthritis.
Holter monitoring, also known as ambulatory or 24-hour electrocardiography, offers an alternate means of testing people for heart disease. By monitoring electrocardiographic activity throughout the day, Holter monitoring can uncover heart problems that occur during the patient's everyday activities. It can also help to recognize any activities that may be causing the heart problems. And it can define and correlate symptoms that may be caused by irregularities of the heart.

Precautions

Holter monitoring is an extremely safe procedure and no special precautions are required.

Description

The technician affixes electrodes on the surface of the skin at specific areas of the patient's chest, using adhesive patches with special gel that conducts electrical impulses. Typically, electrodes are placed under each collarbone and each bottom rib, and several electrodes are placed across the chest in a rough outline of the heart. The electrodes are attached to a portable electrocardiographic device called a Holter monitor, which records the electrical activity of the heart over 24-48 hours. The device is worn over the patient's shoulder or attached to a belt around the waist.
The Holter monitor records the continuous electrical activity throughout the course of the day, while the patient carries out his or her daily activities. During this time, the patient also keeps a detailed log or diary, recording his or her various activities, such as exercise, eating, sleeping, straining, breathing too hard (hyperventilating), and any stressful situations. The patient also notes the time and circumstances of any symptoms-especially chest pain, dizziness, shortness of breath, heart palpitations, and any other signs of heart trouble. Some Holter monitors allow patients to record their symptoms electronically, highlighting the portion of the electrocardiogram recorded while the symptoms are occurring.
After 24-48 hours, the Holter monitor is removed. A computer-assisted analysis is performed on the electrocardiographic recording, and the doctor compares the recording against the patient's log to see if there is any correlation between electrocardiographic abnormalities and any of the patient's activities or symptoms. The physician makes a final interpretation.

Preparation

In the doctor's office, electrodes are attached to the patient's chest. In some cases, the patient's chest hair may have to be shaved to facilitate attaching the electrodes. The patient then begins carrying the monitor on a shoulder harness, in a pocket, or on the belt while carrying out his or her usual daily routine. The patient should inform the doctor of any drugs he or she may be taking, because certain drugs can alter heart rhythms and may affect the results of the test.

Aftercare

The patient returns to the doctor's office to have the monitor and electrodes removed. No special measures need to be taken following Holter monitoring. The test results are usually available within a few days after the monitor is removed.

Risks

There are no known risks associated with Holter monitoring. The main complaint that people have with Holter monitoring is that the monitor may be cumbersome and interfere with certain activities, especially sleeping. Bathing and showering are not allowed during the study.

Normal results

A normal Holter monitoring test shows relatively normal electrical activity in the heart around the clock and no evidence of silent ischemia (deprivation of oxygen-rich blood).

Abnormal results

An abnormal result on Holter monitoring may indicate ischemia to the heart muscle or heart rhythm disturbances. Abnormalities are especially likely to show up during periods of stress or heavy activity, but sometimes serious abnormalities are recorded while the patient is sleeping.

Resources

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.
National Heart, Lung and Blood Institute. PO Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.

Key terms

Cardiac arrhythmia — An abnormal heart rhythm.
Electrocardiography — Recording of the electrical activity of the heart muscle, used to diagnose certain heart abnormalities.

Holter monitoring

Ambulatory electrocardiographic monitoring Cardiology The monitoring of a Pt's EKG over 24 hr period while the Pt records symptoms and activities in a diary; a small portable EKG device is worn in a pouch around the neck; after completion, a correlation is made between the symptoms–or activities recorded and the EKG pattern that was obtained simultaneously. See Myocardial infarction.

Holter monitoring

Continuous recording of the ELECTROCARDIOGRAPH (ECG) using a small, portable cassette recorder. The method is valuable for detecting transient abnormalities that are likely to be missed during the short period of a normal ECG examination.
References in periodicals archive ?
The present study was carried out in order to examine the significance of 24-hour Holter monitoring (For arrhythmias and ischemia) and echocardiography during the early post-infarction period in patients with acute ST elevation myocardial infarction before discharge from hospital.
A holter monitoring is a continuous test to record hearts' rate and rhythm for 24 hours.
Holter monitoring involves having a battery-operated monitor attached to a patient's clothing which monitors electrocardiogram (ECG) readings through electrodes attached to the skin.
Conclusion: Extended 24-hour Holter monitoring in children with palpitations was an inexpensive, non-invasive investigation with a reasonably high diagnostic yield in detecting arrhythmias.
SDNN: standard deviation of all normal RR intervals in the entire Holter recording; SDANN: standard deviation of the average normal RR intervals for all 5-min segments of the Holter recording; SDNNIDX: mean of the standard deviations of all normal RR intervals for all 5-min segments of the Holter monitoring; rMSSD: the square root of the mean of the squared differences between adjacent normal RR intervals over the entire Holter monitoring; pNN50: percentage of differences between adjacent normal RR intervals that are >50 ms computed over the entire Holter monitoring.
In addition to the spirometry and ECHO testing modules, the Diagnostics for Doctors platform also includes modules for Resting ECG, Stress ECG, Ambulatory Blood Pressure, Resting Blood Pressure and Loop and 1 to 14 days Holter monitoring. The Holter monitoring module, in particular, has attracted a great deal of interest from Physicians and in most cases, these tests will be eligible OHIP reimbursement.
He said using the Holter monitoring device for Enrile's heart should continue.
The report provides value, in millions of US dollars, and volume (in units) and average price data (in US dollars), within market categories - Cardiopulmonary Stress Testing Systems, ECG Data Management Systems, ECG Monitoring Equipment, ECG Stress Testing Systems, Event Monitoring Systems and Holter Monitoring Systems.
dollars), within market categories cardiopulmonary stress testing systems, ECG data management systems, ECG monitoring equipment, ECG stress testing systems, event monitoring systems and holter monitoring systems.
An easy-to-use skin-patch device detected 96 arrhythmia events during 2 weeks of use, compared with 61 events detected using 24-hour Holter monitoring, in a study of 146 patients referred for evaluation of cardiac arrhythmias.
The electrocardiogram (ECG) showed sinus rhythm with premature atrial complexes and 48 hours Holter monitoring did not show any other findings.