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24-Hour Holter Monitor

What is a Holter Monitor?

A holter monitor is a kind of electrogardiogram (EKG or ECG) that is used to monitor the EKG tracing continuously for 24 hours or longer. A “resting”, or standard ECG is very simple and one of the fastest ways to evaluate a person’s heart. Small electrodes are placed at certain places on the abdomen and chest. When lead wires to an ECG machine connect these electrodes, it measures and interprets the electrical activity (the heart’s electrical conduction system) of the heart. This information will be printed out for Dr. Golshani to further investigate.

What is the Heart’s Electrical Conduction System?

The heart is basically a pump created by muscle tissue. The pumping action is done by an electrical conduction system that organizes the contraction of different heart chambers. The sinus node (also called SA node or sinoatrial node), a tiny mass of tissue in the right atrium of the heart, generates an electrical stimulus.

The SA node creates an electrical stimulus 60 to 100 times per minute regularly normally. It goes down through conduction pathways (similar to how electricity goes from power lines to a building) and tells the heart to pump out blood and contract. The left and right upper chambers of the heart are first stimulated then contract shortly before the left and right lower heart chambers.

This electrical impulse then goes from the SA node to the AV (atrioventicular) node. It is slowed down for a small period, and then it goes down the conduction pathway into the ventricles. It then divides into left and right pathways to give electrical stimulation to the ventricles (left and right).

All of this is monitored and measured by an electrocardiogram. A tracing (graphic representation) of the electrical activity can be gathered by putting electrodes at certain parts of the body, like the arms, chest and legs. If there are any changes in an ECG from a normal tracing, it might suggest one or more heart-related conditions.

Why Would a Doctor Request a Holter Monitor?

Dr. Golshani may request using a holter monitor if you have symptoms such as fainting, low blood pressure, prolonged fatigue, dizziness, and palpitations that continue to happen without a definite diagnosis from a resting ECG. They will want this tracing to be run over a longer period of time.

Some other reasons your doctor might request a holter monitor include:
  • Assessing future risks for heart-related problems in certain conditions, such as post-heart attack where it left your left side of the heart weak, idiopathic hypertrophic cardiomyopathy (thickened walls from an underlying genetic condition), or Wolff-Parkinson-White syndrome (an abnormal electrical conduction pathway in the heart).
  • Identifying irregular palpitations or heartbeats
  • Evaluating other heart related signs, such as shortness of breath, fatigue, or fainting
  • Assessing an implanted pacemaker’s function
  • Evaluating chest pain that is not reproduced with exercise testing
  • Determining effectiveness of complex arrhythmias therapy
Some dysrhythmias might only occur sometimes, or under certain conditions such as stress. This, along with certain types of arrhythmias, is difficult to get an ECG tracing that runs for several minutes. Therefore, Dr. Golshani might ask for a holter monitor to better capture any abnormal rhythms that might be causing your symptoms. The holter monitor will record continuously for 24 hours, sometimes up to 48 hours. Some might also have an event monitor where you can active at when your symptoms start to occur.

Dr. Golshani will give you specific instructions on how long you will need to wear the monitor, how to keep a diary of your symptoms during the test, and any personal care and activity instructions.

Are There Any Risks using a Holter Moniter?

Using a holter monitor is not an invasive method to assess how the heart functions. Any risks are rare. A risk might happen if you leave the electrode patches on too long. Prolonged contact with the adhesive patches might cause skin irritation or tissue breakdown where it was applied.

Other risks might happen depending on individual circumstances. Check with your doctor to help you address any concerns before you wear a monitor.

What Happens When I Use a Holter Monitor?

Before the Procedure

The procedure will be explained to you in detail by Dr. Golshani. She will give you the chance to ask any questions you might have concerning the reading. You may need to follow specific instructions to prepare, such as fasting.

During The Procedure

Generally, holter monitors tend to follow these steps:
  1. You will be required to take off any jewelry or other objects that can interfere with the reading.
  2. You will need to take off your clothing from the waist up so the technician can attach electrodes to your chest and abdomen. She will cover you with a gown or sheet and only exposing the necessary areas to apply the electrodes.
  3. The holter monitor will be connected with lead wires to the electrodes. The monitor might clip on to a belt or pocket, or be worn over the shoulder.
  4. Hair might be shaved or clipped so the electrodes will stick closely to your skin. Your skin will also be cleaned where the electrodes will be placed.
  5. Once everything is hooked up, you will be given instructions. After that, you can go back to your usual schedule, such as chores, work, and exercise, unless your Dr. Golshani tells you otherwise.
  6. You will be asked to keep a diary during the recording period of your activities. You will need to write the date and time, especially if any symptoms occur, such as dizziness, chest, pain, or palpitations.
After The Procedure

Unless Dr. Golshani tells you otherwise, you should be able to go back to your normal activities. There is normally no special care after a holter monitor recording. If you develop any symptoms you had before your recording, such as dizziness or fainting, let Dr. Golshani know. She may give you more or different instructions after the procedure, depending on your specific situation.

How Can I Ensure That Test Results Are Accurate?

Although everything will be done at the doctor’s office to ensure results are accurate, there are a few things to keep in mind to make sure your test results are as accurate as possible. Make sure to keep the holter monitor dry to make sure the equipment functions normally. You might want to consider taking a shower or a bath before getting the monitor fitted. Try to avoid any type of activities that might get your monitor wet, such as swimming. If you can, try to avoid physical exercise or places where you might end up perspiring a lot, as that can lead to the leads loosening or falling off.

As well, electrical and magnetic fields might interfere with the holter monitor. Stay away from high voltage areas while wearing a monitor. Stay away from electrical appliances such as toothbrushes, hair dryers, electrical blankets and shavers to ensure your results are as accurate as possible. The National Institutes of Health also recommends that patients do not go through a metal detector when wearing a holter monitor.

Smoking and certain medications might affect test results. Be sure to check with Dr. Golshani to see what you can do to help obtain accurate results.

How Do I Know What The Test Results Mean?

After completing testing, you will visit Dr. Golshani to get the holter monitor taken off. She will then look at your activity journal and your monitor results. You might need to get further testing before a diagnosis depending on your test results.

What If I Have An Abnormal Result?

Getting an abnormal result might mean you have different arrhythmias. It might mean that your heart isn’t getting enough oxygen.

The holter monitor may detect conduction block, which is a condition where the atrial electrical activity does not continue to the heart ventricles, or is either delayed.

Dr. Golshani will go with you in detail over what your test results mean, no matter if they are normal or abnormal.

The Art of Healing

Dr. Roya Golshani, a board certified primary care physician, has been practicing general internal medicine since 2002. She is a passionate internist who not only practices internal medicine, but specializes in Women’s Health as well. With her additional training in medical, developmental, and psychological issues, she is fully capable of working with you to solve your problems. Talk with her today to learn more about the holter monitor and how it can benefit you.

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