24 Hours Holter Monitoring
24 hour Holtermonitoring, also known as ambulatory echocardiography, is a diagnostic procedure used for continuously observing and recording the electrical activity of the heart for a period of 24 hours (or more, if required). The procedure is usually recommended after an ECGif the electrocardiogram does not provide sufficient details about the patient’s heart. Unlike regular ECG, which helps to monitor the heart’s electrical activity at a specific point in time, Holter monitoring enables the doctors to do the same over a longer period of time.
The procedure involves the use of a small, portable, battery-operated device known as a Holter monitor. The device is connected to wires having electrodes on its ends, which are attached to the patient’s chest using sticky pads. The patient is required to wear the Holter monitor continuously while performing normal day to day activities.
Why is the procedure performed?
24 hour Holter monitoring may be performed for any of the following reasons:
- To determine whether your treatment and medication are working effectively
- To determine the cause of symptoms like dizziness, chest pain or irregular heartbeat
- To measure heart rate and rhythm
- To detect any abnormalities that might hinder the normal functioning of the heart
Indications of Holter monitoring
Various indications of 24 hour Holter monitoring include:
- Unexplained syncopal episode i.e. losing consciousness
- Significant cardiac or conduction disorder
- An episode of transient cerebral ischemia
- Asymptomatic cardiac ischemia which is also known as silent ischemia
- Severe arrhythmia or any other medical problem that can negatively impact the electrical conduction system of the heart.
- Pacemaker malfunction
The patient is briefed about the procedure and the precautions that are to be followed. It is advisable to take a bath prior to the test as the device cannot be removed once the monitoring starts. The Holter monitor has long leads that are connected to the electrodes. The doctor sticks these electrodes to specific areas on the patient’s chest. This is done with the help of sticky pads. The patient is required to keep a track of all the activities that are performed while wearing the monitor as well as symptoms like palpitations, breathlessness, chest pain and discomfort.
During the procedure
Since the procedure is non-invasive, it is completely painless. Patients can easily cover the electrodes with their clothes and carry on with their day to day activities. A strap may be used to hold the monitor in position. Patients are required to wear the device even when they are sleeping.
While the majority of patients need to wear the device for around 24 hours, some might be asked to wear it for a longer period of time, depending upon the frequency of heart problems like arrhythmia.Patients might be given a form or asked to maintain a diary for recording all their activities. This information is later compared with the Holter monitor recordings.
The patient can remove the monitor on his own and hand it over to the doctor, or visit the lab and let the doctor do it himself/herself. Instructions:
- The patient should not take a shower or swim during the monitoring period. Wet wipes may be used, however, it is important to make sure that the device and electrodes do not come in contact with water.
- The patient is required to refrain from smoking and limit the intake of caffeine.
- Taking x-rays with the monitor on in strictly prohibited
- Rigorous exercises and activities should be avoided as the sweating caused by these can increase the chances of the device getting wet.
- The patient is required to stay away from high voltage appliances and equipment.
- The records should be maintained very precisely
Since the procedure is non-invasive, it is completely risk-free.