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Winter 2011 - The Holter Monitor

H2H - Winter 2011 monitor

You Wear It Well

When it comes to men’s and women’s fashions, there are fly-bynight trends and there are classics you can wear as long as the seams and your waistline allow. In the world of diagnostic (testing) technology, the Holter monitor is one of those classics that continues to prove its worth as a valuable diagnostic tool.

Named for physicist Norman J. Holter, who invented telemetric cardiac monitoring in 1949, Holter monitors were first used in the clinical setting in the 1960s. Their primary purpose is to monitor the heart’s rhythm over a period of time (one to three days) to determine the presence of an arrhythmia (slow, fast or irregular heartbeat).

Holter monitors are used to get a 24- or 48-hour recording of the heart to look for fast or slow heart rhythms. Cardiologists can then correlate the rhythm with the patient’s symptom diary that is kept during the recording. Heart rhythm disturbances can occur sporadically or in conjunction with certain situations such as times of stress. A typical electrocardiogram, which only measures the heart’s rhythm for a few seconds, may not pick up such a problem.

An arrhythmia can result from heart conditions such as hypertrophic cardiomyopathy, which is the leading cause of heart-related death among people under age 30. Hypertrophic cardiomyopathy is a genetic mutation. It causes the heart muscle to grow abnormally thick, which can cause major and minor heart conditions. While some people who have hypertrophic cardiomyopathy experience no symptoms, others can have chest pain, fainting spells and shortness of breath. Others may develop ventricular tachycardia or ventricular fibrillation, both of which can cause sudden cardiac death. These heart rhythm disturbances may not be detected by a typical electrocardiogram. Outpatient rhythm monitoring, such as Holter monitoring, is used to detect patients at risk for dangerous arrhythmias resulting from hypertrophic cardiomyopathy.

While great advances in diagnostic technology for arrhythmia have been made in the past 20 years, the Holter monitor is still relied upon. It is non-invasive, easy to use and not disruptive to patients or their schedules.

Here is how it works and what you need to do to prepare for a Holter monitor test.

  • You will have an appointment for your monitor fitting. A technician will place electrodes that sense your heartbeat on your chest. Using wires, the technician will then connect the electrodes to the recording device, which you can wear on your waistband or belt. The fi tting takes about 20 minutes.

  • You will also be asked to keep a journal of your activities and symptoms and when they occur while you wear the monitor. Be particularly mindful of such symptoms as skipped heartbeats, shortness of breath or chest pain.

  • Aside from bathing, you can go about your regular daily activities while you are wearing the Holter monitor. You are welcome to wash your hair and sponge bathe keeping the water away from the electrodes and wires. Holter monitors are quite reliable, easy to use and subject to very little interference from external energy sources such as power lines, magnets and metal detectors. In order to increase the diagnostic yield of Holter monitoring, it is critical that patients do not vary from their daily routines while wearing the device. For some patients who may have less frequent symptoms, an implantable loop monitor may be a good alternative to the Holter monitoring system and has been shown in several studies to signifi cantly improve our ability to make a diagnosis. There is also a new short-term wireless monitoring system called a Ziopatch that we are currently evaluating in clinical trials. Your cardiologist can help decide which type of monitoring system is best for you.

  • How long you wear the monitor depends on the condition your doctor suspects you have. Once the monitor is removed, the doctor will compare your journal entries with the data from your monitor and diagnose your condition or determine if additional testing is needed.