Holter Monitors – Heart Monitoring for continuous insights

May 30 08:03 2024 by admin Print This Article

Summary

Holter Monitor is a wearable device that is worn by a person whose heart must be monitored for one or more conditions. Unlike an ECG or EKG test which measures heart-rate and rhythm for a short time-span, the Holter Monitor is worn on the body for 24 to 48 hours. The person can go about his daily activities as usual while the device keeps recording the data on a continuous basis. This offers several benefits. In this article, we will learn more.

Introduction to Heart Monitoring

An important aspect of diagnosing heart conditions, is the real-time measurement of heart-rate and rhythm. This is accomplished using tests like Electrocardiogram (ECG or EKG) done by a heart specialist or a cardiac electrophysiologist. ECG records the electrical signals in the heart, and can be used for detecting heart-attacks and arrhythmias (irregular heartbeat). Generally, these are found in hospitals, nursing-homes and clinics. An echocardiogram uses ultrasound to create an image of the heart showing the blood-flow and functioning of valves.

Both the above procedures are done at a clinic and record the heart’s activity over a short period of time, when the patient is resting on a chair or bed. Sometimes, this is not enough to diagnose the person’s condition. A more long-term picture of the heart’s activity is required. That is where continuous heart-monitoring devices come into the picture. These ambulatory monitoring devices focus on a longer time-window like 24 to 48 hours and record data when the person is not at rest (that is what is meant by ‘ambulatory’).

Holter Monitor is exactly one such device and has become extremely popular in a relatively short period of time.

What is a Holter Monitor?

A Holter Monitor is a wearable, electronic device used for monitoring a person’s heart-rate and rhythm. It is approximately the size of a deck-of-cards or a small mobile-phone. It has several electrical leads attached to it. The ends of these leads are connected to electrodes that are placed on the skin using adhesive strips, right over the heart and the abdomen. The entire monitor with leads and electrodes can be worn on the body. Else, the electrodes alone can be placed on the skin near the heart and abdomen, while the monitor and leads can be placed in a bag, belt, pouch or pocket that is worn very close to the heart.

The technicians will show the user how to reconnect the electrodes if they come off. However, the person must wear the monitor for the designated 24 to 48 hours. Electronic circuitry and a battery-pack lie inside the device while the display is what is visible to all. The device is designed for continuous use over a 24 to 48-hour time window.

Why is it required?

1. Symptoms that cannot be captured by a standard ECG: The person may be experiencing various symptoms that are not adequately explained by a standard EKG, so a Holter monitor will be recommended then.

2. Unexplained Episodes of Syncope: Syncope is the technical word for fainting. Persons experiencing syncope and transient cerebral ischemia, which are related to heart-rhythm abnormalities, will benefit from Holter monitoring.

3. Cardiac or Conduction Disorders: Persons diagnosed with prominent cardiac or conduction disorders will require Holter monitoring because of the continuous monitoring over an extended period, which makes for better diagnosis and planning of treatment.

4. Heart Conditions with high risk of ischemia or arrhythmias: For persons with such heart conditions, a Holter monitor is critical as it helps to understand what are the daily activities or stressors​​ that are affecting the heart’s rhythm.

5. Evaluating the effect of heart medicines: If the person is taking medicines for heart conditions, it is important to know how they are affecting the person’s heart-rhythm and conduction-system​​ over time, which is what a Holter monitor does.

6. Pacemaker Evaluations: If there are signs that the pacemaker fitted for a person is malfunctioning, Holter monitoring is done to confirm or rule out malfunction. This will ensure that the pacemaker is managing the heart’s rhythm in the way it is designed for​.

Conditions diagnosed by the Holter Monitor

1. Arrhythmias: Arrhythmias or irregular heartbeats is not just one condition but a set of conditions that includes atrial fibrillation, premature ventricular contractions (PVCs), bradycardia (slowing heartbeat) and tachycardia (rapid heartbeat).

2. Palpitations: A fluttering or racing heart and unexplained dizziness are symptoms of heart rhythm issues. A Holter monitor will help detect the exact location and type of heart rhythm abnormalities​​, so that the right treatment can be given.

3. Assessing oxygen supply and efficacy of medication: People with heart conditions who are on medication must be monitored for how well the medicines are working and whether the heart is receiving adequate oxygen supply or not. Holter monitoring is ideal for this.

4. Detecting occasional arrhythmias: Occasional heart-rhythm abnormalities are a risk factor for heart-failure and may be missed by a standard ECG. Since Holter monitoring covers a larger time-window like 24 to 48 hours, it is easier to capture such events.

5. Further Diagnosis: If the regular Holter monitor does not capture arrhythmias, then the cardiac electrophysiologist will recommend another device called an event recorder. This is worn for a longer duration like several weeks and captures data when the person is feeling symptoms.

How is the Monitor used?

Process

• The person must remove all accessories around the chest as these can interfere with the reading. He/she must also remove the upper clothing.
• The spots where electrodes must be placed in the chest and abdomen will be selected. Body hair at the spots will be shaved so that the electrodes stick well to the skin. The monitor will now be connected to the electrodes.
• The person will be given a bag, pouch, pocket or belt to hold the monitor. He/she must carry the monitor and electrodes on the body throughout the test-period.
• The technician will brief the person on how to place and carry the monitor, how to check and change the batteries, and how to note both daily activities and symptoms (together called events) through the day.

Dos

• The person must maintain the events diary without fail. The person must record what he/she was doing when a particular symptom occurred, what he/she had eaten recently and how stressed/relaxed he/she was then.
• The person must keep all electrical and electronic appliances like phones, laptops, electric toothbrush, electric shaver, electric blanket, etc at a minimum distance of 15 centimetres away from the Holter monitor.
• The person must continue with his/her normal, daily routine without making any changes to the same. He/she can also exercise lightly as long as the electrodes and monitor are in place.
• He/she must limit consumption of alcohol and caffeine and preferably not smoke.

Don’ts

• The person must avoid contact with water completely. So showering, swimming and water-sports are forbidden during the test period.
• Vigorous exercises are forbidden as the excessive sweating caused by that can loosen the electrodes.
• Cigarette smoking is a strict no-no
• The use of microwave ovens for cooking or heating food is forbidden as the electromagnetic waves from the same can affect the device.
• The use of electric appliances must be minimized in the test period.
• The person must not get an X-ray, CT scan, MRI or ultrasound undertaken in the test period.
• He/she must keep a healthy distance from magnets and any magnetic field.
• He/she must avoid high-voltage areas, like HV towers and HV electric lines.
• He/she must not allow scanning by metal detectors.

Results and Follow-up

The results of the test will be provided in a week’s time. Best heart doctor in Salem will discuss the readings and whether they indicate any condition (such as atrial fibrillation, PVCs, tachycardia and bradycardia) or not. Based on the condition diagnosed, the doctors will start the person on a course of treatment.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 •  Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801