24-Hour Holter Monitoring
What is a Holter Monitor?
A Holter Monitor is a portable battery-operated electrocardiogram (ECG) device, which is about the size of a cell phone, that is attached to the body to measure and record a person’s heart rhythm and rate. It records the heart’s activity for a continuous period of 24 hours or longer depending on the type of monitoring used. The Holter Monitor is named after Dr. Norman J. Holter, who invented the ambulatory electrocardiographic system in 1957. It is also called ambulatory electrocardiography. The doctor recommends and suggests Holter monitoring when the standard electrocardiogram (EKG or ECG) is unable to provide sufficient information regarding the heart functions to diagnose or detect the heart’s condition.
The Holter Monitor device is equipped with several electronic wires or electrical leads and electrodes or sensors that are attached to the body, in particular the areas of the chest, in a similar way to a standard electrocardiogram (EKG or ECG). It tracks and monitors the electrical activity of the heart as individuals go about their daily lives outside the hospital away from the doctor.
The doctor determines the duration for wearing the device, which usually ranges from 12 to 48 hours, depending on the symptoms and their frequency. During that time, the device tracks and records all of the heart activities. After the wearing period is over, the doctor reviews the information recorded on the monitor which in turn helps in detecting if the patient has a heart problem.
Why is Holter monitoring used?
A standard electrocardiogram (EKG) is a medical test that is usually used when a person experiences symptoms and signs of heart problems to diagnose the problem. It is a quick or short-time test that measures the heart’s rate and rhythm and other abnormalities affecting the normal functioning of the heart. However, EKG only detects the symptoms of heart abnormalities when they appear within a short period of the test. Since abnormal or irregular heart rhythms and other symptoms appear sporadically, they are often unlikely to appear at the time of the test conducted briefly at the hospital or clinical setting. Thus, there is a significant probability that the symptoms remain undetected despite conducting the test.
If the patient experiences an irregular heartbeat or heart palpitations, but an EKG fails to detect anything, a Holter monitoring can help diagnose the problem. The sporadic nature of the symptoms and signs of heart abnormalities requires continuous monitoring of the heart’s activities to help diagnose the underlying condition. Therefore, Holter monitoring is recommended as it monitors and records the heart’s activity for a period of 24 hours or more, allowing the symptoms to be recorded whenever they appear. The doctor analyses the recorded information of the monitor to diagnose a variety of abnormal heart rhythms or arrhythmia and heart conditions.
Holter monitoring is also suggested if a resting ECG is unable to find the clear cause of the following symptoms of heart-related conditions:
- A fast or slow heartbeat
- Dizziness or fainting
- Tiredness or fatigue
- Chest pain
- Shortness of breath
- Palpitations or irregular heartbeats
- Low blood pressure
Moreover, in the case of heart patients receiving treatment and medication, the test helps the doctor to monitor and check the effectiveness of the treatment or medicine, or understand if changes are required. Holter monitoring also allows the patients to feel comfortable as they can to carry on with their daily routines while being monitored while sparing them lengthy hospital stays.
What are the risks of a Holter monitor?
Holter monitoring is a safe, painless, and one of the best tests to identify potential heart problems or other issues. There are no serious risks involved in wearing a Holter monitor and the risks involved are minimal and rare. For instance, there might be a minor skin irritation at the site where the electrodes were attached to the skin when wearing the monitor for a long time.
However, there are certain factors or conditions which may affect the results of the Holter monitor reading by interrupting the signal between the sensors and the monitor that one needs to avoid. These are:
- While wearing the device, one should avoid engaging in water-related activities such as swimming and taking bath as the Holter monitor can get damaged if it gets wet. In the case of a wireless Holter monitor, the patient should know how to disconnect and reconnect the sensors and the monitor to take a shower.
- Sweating too much while wearing the device can cause the leads that are attached to the skin to come off. This can interfere with the recording of the heartbeat.
- If you are wearing the device, you should keep away from certain things that can disrupt or interrupt the signal between the sensors and the monitor such as electric blankets, electric razors and toothbrushes, magnets, metal detectors, high-voltage electrical wires, and microwave ovens.
- Also, cell phones can interfere with the signals and therefore need to be kept at least 6 inches away from the Holter monitor.
What happens during a Holter Monitor test?
The Holter Monitor test is a painless and non-invasive procedure. The electrodes connected to the small Holter device are attached to the chest and are hidden under the clothes.
- The patient should wear the monitor all the time and never remove it even while sleeping.
- The doctor will also instruct the patient to keep a diary to note down the details of daily activities and the exact time of doing them.
- The patient is also required to maintain a record of any specific symptoms the patient experiences such as chest pain, dizziness, light-headedness, and shortness of breath.
- The doctor will recommend the length of time the patient needs to wear the monitor device based on the patient’s condition and the frequency of the symptoms of a heart problem.
What happens after a Holter Monitor test?
After the recommended monitoring period is over, the patient needs to go back to the doctor’s office to get the device removed. The doctor will go through the patient’s diary where s/he has kept a record of symptoms that s/he had experienced while wearing the device. The doctor then compares and analyses the data from the Holter monitor with the patient’s notes to diagnose the condition. The information from the Holter monitor can also reveal if the medicines the patient is currently taking are working or not working or needs changes. The doctor will remove the Holter monitor and talk to the patient about the results. Based on the results of the test, the doctor will recommend an appropriate treatment plan to help her/him manage the symptoms moving forward or one may be required to undergo further diagnostic testing.
Dr. Alok Sehgal (Chief Consultant, Interventional Cardiology)
Dr. Alok Sehgal is a dynamic and dedicated cardiologist, who has an experience of more than 20 years in the medical field with numerous distinguished cardiologists in various hospitals. He specializes in all kinds of diagnostic peripheral vascular diseases, and cardiac catheterization and has undertaken angiographic studies on adults and children spanning the spectrum of congenital, rheumatic, coronary, and peripheral arterial disease. Besides being the Chief Consultant of Interventional Cardiology at Yashoda Hospital & Research Centre, he has been training residents, technicians & nurses in the cardiac catheterization laboratory, coronary care unit & the wards. He performs more than 150 angioplasties and over 500 diagnostic cardiac procedures annually.
Dr. Amit Rai (Senior Consultant, Cardiology & Medicine)
Dr. Amit Rai is highly experienced in the field of clinical cardiology and medicine and has worked in the medical field for more than three decades. He completed his M.B.B.S. in the year 1986 from Rani Durgavati Vishwavidyalaya, Jabalpur, Madhya Pradesh, and his M.D. from Govt.
He is the Senior Consultant of Interventional Cardiology at Yashoda Hospital & Research Centre, Ghaziabad. He completed his fellowship in non-invasive cardiology from Navin C. Nanda National Institute of Echocardiography & Cardiac Research, New Delhi. He has also published various papers in both national and internationally indexed journals.
Dr. Rajat Arora (Group Director, Yashoda Group of Hospitals, Uttar Pradesh Consultant Interventional Cardiologist)
Dr. Rajat Arora is the incumbent Group Director of Yashoda Group of Hospitals, Uttar Pradesh as well as the Co-Founder of Seeds of Innocence (Infertility & IVF Centres) and Genestrings Diagnostic Centre (Genetic Testing Lab) in Delhi NCR. He has exceptional educational qualifications starting from M.B.B.S. and M.D. in India to MRCP & FRCP in internal medicine from the UK. He has also been a fellow in Non-Interventional Cardiology at KLE University and completed his D.M. in cardiology from KLE’s Hospital. With an experience of more than 15 years in the field of cardiology, he is highly acknowledged for having effectively managed various healthcare services across the spectrum.