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The EKG recorder is still the most used type of ambulatory electrocardiographic (EKG) monitoring. It is named after the inventor of the American biophysicist Norman J. Holter. As with any type of outpatient ECG monitoring, the main purpose of the Holter test is to analyze the electrical activity of the heart outside the clinical setting, i.e. when the person is carrying out their daily activities. The EKG recorder is a 24 or 48 hour monitoring device, and the ECG recorded at that time is then analyzed for any cardiac arrhythmias that may have occurred during the monitoring period, as well as any signs of ischemia.
EKG recorder – the purpose of the study
There are many types of arrhythmias that can cause different symptoms and vary enormously in their medical significance and treatment. So, if there is a suspicion that a person has an arrhythmia, it is important to carefully diagnose the nature of the arrhythmia to decide what, if any, to do about it. This means that the arrhythmia must be captured on an EKG.
However, many cardiac arrhythmias occur rarely and completely unpredictably – and often only occur for a short time. The chances of catching one of these rare or fleeting arrhythmias while a healthcare professional takes a standard ECG (which records the heart’s rhythm for only 12 seconds) is quite small.
In addition, symptoms caused by arrhythmias may also only last for a short time. By the time the person experiencing symptoms enters a medical facility to have an EKG recorded, too often the symptoms (and the arrhythmia that caused them) disappear.
The EKG Holter was developed to solve the problem of diagnosing rare or transient arrhythmias. By recording every heartbeat that occurs over a long period of time while performing daily activities, the chances of detecting one of these transient arrhythmias are greatly increased.
See also: Why do young people die of heart disease? Cardiologist: there is a common denominator
EKG recorder – indications
An EKG recorder is most often used when a person has transient episodes of symptoms that can be explained by a disturbance in the heart rhythm. The most common symptoms are:
- fainting or near fainting;
- unexplained dizziness;
- palpitations.
Much less frequently, the Holter EKG can also be used to look for episodes of ischemic heart disease that do not cause angina. Since this ischemia does not cause symptoms, it is often referred to as “silent cardiac ischemia” or “silent cardiac ischemia”. However, ECG changes due to Holter ischemia are often quite nonspecific, and such ECG changes can be confusing. In this case, most cardiologists do not often order a Holter test for this purpose, unless they are dealing with a patient who is known to have had silent ischemia. This may be, for example, someone who has been diagnosed with silent ischemia in an exercise test or who has had a history of stress test. “Silent heart attack”.
Holter EKG tests are most often used to diagnose cardiac arrhythmias.
Other indications for the examination include:
- congenital heart defects;
- assessing the effectiveness of treating arrhythmias;
- monitoring the work of the heart in people who have had a pacemaker or cardioverter-defibrillator;
- planning heart surgery;
- irregular heartbeat during pregnancy (an irregular heartbeat may harm your and your baby’s health).
See also: Heart failure is a silent epidemic in Poland. The cardiologist tells you what the symptoms are
Holter EKG – contraindications
The EKG recorder carries virtually no risk with the exception of a slight risk of skin irritation at the electrode site.
Holter EKG testing is not always the best type of outpatient ECG monitoring. If there is good reason to believe that the arrhythmia you are trying to diagnose is so rare that it is unlikely to occur within any given 24-48 hour period, consider another type of ambulatory ECG monitoring that may be followed over several weeks ( or longer).
Holter EKG – preparation for the test
Knowing these details before the test can help ease any anxiety or anxiety the patient is experiencing.
The term Holter ECG
The doctor and the patient will jointly decide on the appropriate time to perform the test. Almost any 24-48 hour period will usually suffice, but it’s best to choose a time when the patient is not traveling (to avoid the hassle of airport security), does not schedule water activities or activities that will require entering the water (stay dry while wearing the Holter EKG).
Place
The patient will have to go to the clinic or hospital for the technician to connect the recorder. It only takes a few minutes. The patient will be asked to return to the same facility to remove the Holter EKG. It is very important not to try to remove the Holter ECG yourself, only personnel with appropriate training in the use of the device will complete the recording, which is a guarantee that the examination was carried out and ended correctly.
What to wear before the Holter EKG?
While any comfortable clothing can be worn, a loose top is required so that the Holter EKG can be worn comfortably underneath.
What to remember before the Holter EKG?
The patient is allowed to eat and drink as usual before the test and (unless otherwise instructed by the doctor) may take normal medications. It is a good idea to take a bath before starting the Holter ECG test as this cannot be done while wearing the recorder.
Holter EKG cost and health insurance
The cost of the study varies. Almost all health insurance covers Holter EKG tests as long as they are prescribed by a licensed physician.
EKG recorder – the course of the examination
The EKG recorder consists of several tiny patches of electrodes that adhere to the skin and are attached with small wires to the recording device. The recording device (it used to be a small tape recorder, today it is more and more often a digital recorder no larger than a deck of cards) can be worn around the neck or attached to a belt. The electrodes, wires and recording device are hidden under clothing. At the end of the test, the electrodes and leads are removed and the recording equipment is returned to the laboratory for analysis.
Upon arrival at the medical facility, the technician will place the electrodes in the appropriate places on the chest and attach them to the recorder. It is essential that the skin on the chest (where the electrodes are to be attached) is washed, without the use of creams or lotions, which could cause the electrodes to fall off the skin. In the case of profuse chest hair, the patient may be asked to shave it off.
The technician will help you decide how to wear the recording device, instruct you on the do’s and don’ts, and tell you how to keep a diary of your actions and symptoms. The device will monitor and record your heart rate in detail for 24 hours. In justified cases, the test time may be extended to 48 hours.
During the test, the patient will simply follow the normal daily routine with two big exceptions. First, he will need to keep the device dry so he cannot shower or wash his chest (the patient may use wet wipes or a sponge and soap to clean areas such as the face, armpits, buttocks, and groin). It is also recommended to avoid the use of electric pads, metal detectors, and to keep the mobile phone near the ECG recorder (magnetic or electric fields may reduce the accuracy of the reading). It is also important to be careful when dressing, so that the electrodes are not accidentally disconnected and the recording is interrupted (it is recommended to avoid sleeping on the stomach during the test).
Second, the patient will need to keep a diary of all activities they are doing and any symptoms that may occur while wearing the EKG Holter. The doctor in particular will be most interested in symptoms such as dizziness, palpitations, fainting, chest pain, or shortness of breath. The exact time of these symptoms onset will be compared with the electrocardiogram.
After the examination is completed, the patient will return to the medical facility to remove the device.
See also: These wipes can cause allergies. Scientists warn
ECG recorder – procedure after the examination
The patient should expect to receive information from his doctor about the results within one to two weeks and discuss possible next steps.
If you experience skin irritation due to the electrodes (which is rare), contact the examiner (also for any other problems during the test, such as unexpected events such as a fall, electric shock, wetness, electrode detachment, or other events that may affect the proper examination of the test. ).
Holter EKG – interpretation of results
The physician should contact the patient about the results or schedule a return visit in advance to discuss the results of the ECG test.
Only a physician can interpret Holter ECG measurements. It is not worth trying to do this on your own.
When interpreting the results of the Holter test, it should be remembered that the most common purpose of this test is to determine whether the unexplained symptoms are due to cardiac arrhythmias or not. This means that symptoms do correlate with concurrent arrhythmia, which is crucial for making a diagnosis.
Many people (in fact, most people) have occasional, mild types of arrhythmias that do not cause any symptoms. The diagnosis of such an arrhythmia on a Holter ECG test without concurrent symptoms indicates that the arrhythmia is not a problem and (usually) does not require further treatment.
On the other hand, when symptoms correlate well with cardiac arrhythmias, it is the arrhythmia that is causing the problem (at least causing the symptoms) and deserves appropriate steps to be taken.
The physician may also discuss with the patient other results reported in the device report, including maximum, minimum, and average heart rate, total premature atrial complex (PAC), and premature ventricular contraction (PVC) that are the patient may have had and any episodes of possible ischemia.
If a Holter scan is performed to look for silent heart ischemia, finding strong signs of ischemia on the test is likely to lead to further tests, such as an exercise test (electrocardiographic exercise test) or cardiac catheterization, or to changes in the patient’s ischemic treatment.
See also: Correct heart rate – norms, how to measure? Fast and slow heart rate
EKG recorder and pressure recorder
In addition to the Holter EKG, there is also the so-called Pressure recorder (Holter abpm or Holter rr) that measures the pressure value. The device records changes in blood pressure within 24 hours. The device is similar but has a cuff.
During the test, the blood pressure cuff will be attached to your upper arm and the recorder will be at hip level. The recorder usually records blood pressure every 30 minutes during the day and every 2 hours at night. Automatic cuff inflation can cause an unpleasant feeling of pressure in patients with particularly high blood pressure values. It is not recommended to make large-scale movements with the arm that is equipped with a cuff, nor to wet the arm (bath, shower, etc.). After the test, the device is removed and connected to a computer, where a special program reads the measurements and interprets the results.
The pressure recorder also helps in making a specific diagnosis and is very accurate, because the device performs many measurements, which in turn has a positive effect on the reliability of the measurements.
It is worth adding that there is another version of the Holter known as the Holter EEG, which studies the electrical work of the brain with the help of electrodes attached to the patient’s head.