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How to put on a heart monitor. How is 24-hour heart monitoring done?

A regular electrocardiogram in the doctor's office does not always give an accurate result. During this short time, it is not possible to obtain complete information about the work of the heart during sleep, during physical and mental stress and during a normal lifestyle. Daily monitoring of the heart according to Holter helps to complete the picture of the examination.

Holter ECG, or daily heart monitoring: the essence of the examination

To obtain the above data, an electrocardiogram (ECG) is required over a long period of time. To do this, electrodes similar to those of a regular examination are attached to the patient's body, connected to a wearable cardio recorder. The information is read by the device and written to the memory card, and then transferred to the doctor of functional diagnostics for interpretation and conclusion. This examination can take up to seven days.

24-hour ECG monitoring was first used by American biophysicist Norman Holter in 1952, which is why the method is often referred to as Holter ECG. With the advent of this technology, it has become much easier to identify violations of the heart rhythm and conduction, to clarify the cause of sudden fainting, to evaluate the work of the pacemaker, to identify ischemic changes in the patient.

A heart monitoring device (monitor) looks like a small box with a memory card inside. Connected to it are wires leading to several disposable electrodes on the patient's body. The recorder itself is in a case on the belt, so that it is convenient to carry it. After the end of the daily ECG, the electrodes are removed, and the device is connected to a computer, where the data becomes available to the doctor. The main condition for wearing the device is physical activity, if there are no contraindications.

In some cases, the patient is also prescribed a daily measurement of blood pressure. Then, a cuff-tonometer is added to the equipment described above, which fixes blood pressure and also transmits information to the monitor.

The registrar records the heart rate during the day, and the patient at this time keeps a diary in which he records the time of sleep, work, meals, walking up the stairs, etc. The doctor may also ask the patient to perform tasks while wearing the monitor: for example, spend 5 minutes lying in a certain position (on the back, side, stomach) and mark the time in the diary. So daily ECG monitoring will be as informative as possible.

Indications and contraindications for 24-hour heart monitoring

Daily monitoring of the work of the heart is prescribed in the following cases:

to detect arrhythmia, if there are complaints of interruptions or pauses in the rhythm of the heart, too frequent or very slow heartbeats, dizziness or fainting;
to detect ischemic conditions (oxygen starvation) of the myocardium: the patient may complain of pressing pain in the chest, elbows and lower jaw;
to control certain parameters of the pacemaker;
to assess the effectiveness of the prescribed treatment.

Important!
If, according to the results of daily ECG monitoring, arrhythmia or ischemia was not diagnosed, then this does not give an absolute guarantee of their absence. For an accurate diagnosis, the patient should be assigned a comprehensive examination, load stress test on a track or bike.

Some devices for monitoring the heart rhythm allow you to make an initial diagnosis automatically. But one should not completely rely on these data, only the doctor after analyzing the decoding of the data gives the final conclusion.

Other indications for cardiac monitoring are:

strong heartbeat;
angina;
myocardial infarction;
cardiomyopathy.

Only acute inflammatory heart disease is considered a contraindication to daily ECG measurement. In all other cases, the examination does not harm (and is absolutely painless), including during pregnancy, in childhood and old age.

Heart monitoring procedure: procedure

Many patients are interested in how daily heart monitoring is carried out, how the device will be installed and whether it is necessary to consult a doctor.

First you need to get a doctor's prescription. There should be a clear direction with the purpose of the study, as well as recommendations: for example, whether any medications taken should be discontinued during monitoring.
Before the examination, it is advised to get enough sleep and start the day as usual. It is advisable to take a shower without lubricating the skin after it. If there is hair on the chest, it should be shaved off for better contact of the electrodes with the skin and subsequent painless removal. It is advisable to wear loose clothing to hide the device and electrodes and to walk comfortably with them. It is undesirable for women to wear a bra with underwire.
In the treatment room, a nurse attaches adhesive disposable electrodes to the front of the patient's chest. Usually there are five to seven of them, but the number can reach up to 12. Sometimes one electrode is attached closer to the groin. The device itself is in a special bag, it can be hung around the neck, over the shoulder or on the belt.
The nurse also turns on the registrar, and after that the device does not need to be touched until the end of the examination. Sometimes the patient is given the task to press the button at a certain moment, but this does not happen every time.
Daily monitoring of the heart is not necessarily carried out during the day. The duration of the study is determined by the doctor. After the expiration of the appointed time, the patient again comes to the treatment room, where the device and electrodes are removed from him, the quality of the data recording is checked and sent for decoding.
During the examination, a cell phone should not be in your pocket, and it is also forbidden to approach electrical appliances with radiation.

What can not be done during the study?

During daily monitoring, any water procedures are strictly prohibited (except for those in which water does not touch the equipment).

Do not sleep on your stomach, as this can cause the electrodes to detach. If they are still peeled off, you should return them to their place. In other cases, do not touch the electrodes or press any buttons on the device without instructions from a doctor or nurse.

It is necessary to record in the diary all actions according to the doctor's recommendations (sleep, food intake, medication, changes in well-being, etc.).

If possible, you should give yourself physical activity (usually walking up the stairs) with a record of its type, duration and well-being after it.

Survey results

It is difficult for a person who is not a specialist in functional diagnostics to figure out what daily heart monitoring shows. The data written to the instrument consists of terms, numerical values, charts and graphs. Therefore, the patient should provide the doctor with a study of the data and the diagnosis, the appointment of treatment or additional examinations. Transcription of the notes usually takes several hours, so in most cases the patient is asked to come to the consultation the next day.

The conclusion of the doctor will allow you to understand whether the patient has signs of disorders such as ischemia and arrhythmia, whether there is a danger to life and health, whether hospitalization or surgery is needed. It is necessary to approach the examination seriously and follow all the instructions of the specialist, since it depends on whether it will be possible to stop the development of the identified violations.

With the appropriate indication of the doctor, do not neglect the daily monitoring of the ECG. Pathologies of the heart, if present, are best detected in advance and treatment should be started as soon as possible. Such an examination will not cause any harm - no deterioration in the well-being of patients after Holter monitoring was observed. Therefore, if you have been assigned daily ECG monitoring, immediately find out where to do it and start preparing for the procedure.

From this article you will learn: what is Holter monitoring, to whom it is prescribed, how it works. Examination rules, contraindications and side effects.

Article publication date: 02/10/2017

Article last updated: 05/29/2019

24-hour Holter monitoring is a diagnostic electrocardiography procedure in which the electrical activity of the heart is recorded throughout the day using a portable device.

This diagnostic method is prescribed by a heart disease specialist: a cardiologist or arrhythmologist.

Indications for carrying out

What symptoms are prescribed

Holter ECG monitoring is prescribed to a patient with the following symptoms:

pain and burning in the chest;
increased heartbeat;
dizziness;
dyspnea;
fainting or pre-fainting states.

This procedure is especially popular when the patient is worried about unpleasant symptoms, and the usual electrocardiogram and ultrasound of the heart showed no abnormalities.

For accurate diagnosis of arrhythmias

Such an examination is prescribed for patients with suspected ciliary (paroxysmal) tachyarrhythmias. They are almost impossible to diagnose using a conventional ECG, as they manifest themselves in the form of seizures, and the patient cannot come to the diagnosis right during one of them. Paroxysmal tachyarrhythmias can appear with such diseases:

congenital heart defects (WPW syndrome, LGL syndrome, cardiomyopathy);
transferred myocardial infarction or multiple microinfarcts;
angina;
myocardial ischemia.

You can also diagnose other types of arrhythmias, for example, extrasystole.

To monitor the effectiveness of treatment

Daily monitoring of heart activity is prescribed to monitor the effectiveness of treatment (for example, after ablation of an additional pathway in WPW syndrome).

In addition, a Holter examination is recommended to pass after - to check whether it works correctly.

Preparation for the examination

No complex special training is required.

Also, tell your doctor if you are taking any medications.

How is Holter monitoring performed?

The procedure is very simple:

The patient undresses to the waist.
At the place of attachment of the electrodes, the hair is shaved and the skin is degreased with alcohol.
Special disposable electrodes (similar to those used in a conventional ECG) are attached to the body.
A battery-powered device is attached to the electrodes by wires, which registers the electrical activity of the heart throughout the day and saves it to the built-in memory. It can be fastened to the patient's body using a special belt or fixed in another way for the convenience of the subject (so that you do not have to carry it in your hands or in your pocket).
With the device, the patient leads his normal life. Sometimes the doctor may ask the patient to do some physical exercise during the Holter monitor. This is necessary in order to assess the reaction of the heart to stress and its recovery after them. Also, the doctor may ask you to keep a diary in which the subject writes down what and at what time he did during the day and when he went to bed.
A day later (this is the minimum examination period, sometimes the doctor may prescribe a longer ECG monitoring - up to 7 days), the patient comes to the clinic to remove the device.
At the end of the procedure, disposable electrodes are peeled off and discarded. A specialist connects the device to a computer. Then it views and decrypts the received data.

What to write in a diary

If your doctor has told you to keep a diary, you will need to write down the key moments of your day. Be sure to record the time:

taking medications;
food intake;
sleep (both night and daytime, if any);
emotional stress, if any;
activities of different activity (be sure to record the exact moment of changing activities of different activity, the time of their change can be recorded approximately).

Category	Examples
Passive rest and low physical activity	Watching TV, reading, needlework, studying, writing
Activities that may require emotional stress	Playing computer or gambling games, driving
Activities with light physical activity	Walk in the park, morning exercises
Average physical activity	Climbing stairs above 3 floors, light jog
Intensive loads	Workout in the gym, jogging for more than 20 minutes. Attention! Be sure to check with your doctor if you can perform this kind of action during daily ECG monitoring. In addition, make sure that the electrodes do not come off during the exercises and the data recording device is not damaged.

Be sure to record the time when activities from one category change to activities in another category.

If during the period of the study you felt any unpleasant symptoms (dizziness, palpitations, and others), be sure to list them in a diary and write down the time.

Rules for the patient

In order for the results of daily monitoring of the electrical activity of the heart to be as accurate as possible, certain rules must be followed:

Wear tight clothing made from natural fabrics. It is better not to wear loose clothing, as the electrodes can peel off from the body in it. And synthetic fabric can become electrified, which will distort the readings of the device. There should be no metal elements on clothes above the waist.
Do not overcool or overheat the device.
Do not allow water or other liquid to come into contact with it.
Do not place it on vibrating surfaces.
Do not stay near electrical equipment or transformer boxes.
Do not use your laptop or mobile phone for more than 3 hours a day. Do not bring the gadget closer than 30 cm to the device for Holter ECG monitoring. Do not get close to a working microwave oven.
Do not sit or lie down on the device. Lay it so that it won't be crushed while you sleep.
Make sure that the electrodes do not come off.
Do not undergo physiotherapy procedures and do not take x-rays during the examination.
Ask your doctor ahead of time if you can exercise during your exam.

Decrypted data

On the results sheet, you will see the following indicators.

Indicator	Norm
Average heart rate during the day	60–100 beats per minute
Average heart rate at night and during daytime sleep	41–81 bpm
Daily heart rate chart	Changes when changing activities
Quantity	Up to 960 per day (up to 40 per hour) A slight excess of the norm (up to 1200 pieces per day) does not pose a threat to life and health
Number of ventricular extrasystoles	Absolute norm - 0 Permissible quantity that does not threaten life and health is 200 pcs. per day
The duration of QT and PQ intervals and the schedule of their changes.	QT interval norm: 340-450 ms (0.34-0.45 s) for women and 340-430 ms for men PQ - 120-200ms

Note! The norms indicated in the table are averaged and do not take into account the age and individual characteristics of the organism. Find out about the norm for you personally from your doctor.

Click on photo to enlarge

Contraindications and side effects

Holter monitoring is a completely painless procedure.

Has no contraindications. It can be used, including during pregnancy and breastfeeding, as well as in the elderly and children.

Does not cause side effects.

In case there are problems with the heart, the electrocardiogram is not always informative. Often it is required to fix the work of the main muscle of the human body for a longer time. For this, Holter monitoring of the heart is used.
Why Holter ECG is used and in what cases it is necessary - we will tell in this article.

Holter monitoring of the heart (24-hour ECG monitoring) is a method of continuous recording of an electrocardiogram (ECG) for a day or longer using wearable cardio recorders (monitors).

The essence of the study is to permanently record the ECG on a memory card located in the device. After processing this record on a computer, the doctor of functional diagnostics gives a conclusion about the rhythm, its disturbances, ischemic changes, and the presence of pauses.

The method got its name from the name of the scientist who first used long-term ECG recording in 1952.

What is the method used for?

Before conducting daily ECG monitoring, the patient should be examined by a therapist or cardiologist. This is necessary for the correct execution of the referral for the study, clarification of the details of the examination (for example, drug withdrawal), and the formulation of the diagnosis.
Daily ECG monitoring reveals:

type of heart rhythm and heart rate;
rhythm disturbances (, paroxysmal arrhythmias, pauses);
ischemic ECG changes caused;
in some models, heart rate variability.

Daily ECG monitoring is used in the following situations:

diagnostics for complaints of rapid or slow heartbeat, interruptions in the work of the heart, irregular pulse, episodes of dizziness, severe weakness or loss of consciousness, a feeling of cardiac arrest;
diagnosis of ischemia (oxygen starvation) of the myocardium in case of complaints of pressing, squeezing, burning pains behind the sternum, especially during exercise, before prescribing, complaints of a feeling of "coma in the throat", heartburn, episodes of pain in the lower jaw or elbows;
control of the work of the installed;
monitoring the patient's condition in dynamics, including monitoring the effectiveness of treatment.

How to prepare for the procedure?

In the morning before the study, you must take a hygienic shower. Do not lubricate the skin with anything, it should be dry and clean. Men are strongly advised to shave their chest hair: this will not only save you from the painful removal of the electrodes, but also significantly improve the quality of the recording.

If you need to purchase batteries for the monitor, you need to pay attention to the markings. Batteries must be alkaline (alkaline), size AA ("finger") or AAA ("little finger").

If the adhesive plaster is poorly tolerated, it is advisable to purchase a special hypoallergenic silk-based plaster at the pharmacy. It will help avoid skin irritation.

Before the examination, it is advisable to get enough sleep, usually have breakfast, without rushing to come to the clinic. The patient will be more comfortable if he puts on a tight-fitting T-shirt, and on top - loose clothing, under which it will be possible to hide the registrar. Women are advised to wear a bra.

How is the examination carried out?

On the anterior surface of the chest, the nurse attaches round disposable electrodes, securing them with adhesive tape. Most often there are 5 - 7 of them. Wires go from the electrodes to a small device - a registrar. The registrar is hung on the patient's neck (rarely on the belt) in a special case. After turning on the recorder, ECG recording starts. After that, you do not need to touch the monitor. It is only necessary to press any buttons on it when receiving such an instruction from a nurse, and this is not necessary.

The patient is given an observation diary. In it, he must indicate the time of night's sleep (what time he went to bed in the evening, what time he got up in the morning). In some clinics, the patient is recommended to record all his actions and feelings during the day. In others, it is recommended to perform several loads.

Most often, the patient is recommended to climb the stairs several times during the day until tired (without any extra effort), noting the start time of such an ascent and indicating their feelings after the load. Such an entry in the diary will help the doctor determine the relationship of ECG changes with stress and complaints.

If during the day the patient felt interruptions in the work of the heart, palpitations, he developed dizziness or some other complaints, this should also be noted in the diary. It is not necessary to write in detail, the main thing is to indicate the time of such complaints.

It is worth noting the time of taking medications. It is not necessary to constantly measure and record blood pressure. It is necessary to note the time of eating, rest, emotional stress, if they somehow changed the state of health.

The patient should sleep as usual, but not lying on his stomach.

When peeling off the electrodes, you need to attach them back.

The next morning, the patient returns to the office to remove the monitor. After that, the record is analyzed by the doctor. This process can take several hours, so most often the result is ready the next day.

During the examination, you can not pass through the metal detector in shops, stadiums, and so on. You can use your mobile phone and computer. It is impossible to carry out radiography or magnetic resonance imaging of any organs. Ultrasound is possible as long as it does not involve the chest and interfere with the recording.

Indications

Complaints about episodes of dizziness, loss of consciousness, heart rhythm disturbances.
Examination for transferred, hypertrophic cardiomyopathy, and other severe heart diseases.
, long QT syndrome.
Suspicion of asymptomatic myocardial ischemia.
Suspicion of sleep apnea syndrome (a special program for the analysis of apnea is used).
Control of the pacemaker.

Contraindications

24-hour ECG monitoring is not indicated for acute inflammatory diseases of the chest skin. There are no other significant limitations for this study. It can be performed at any age and with any concomitant diseases.

What to do after the study?

Analysis of 24-hour ECG monitoring is a text with a lot of terms, numbers, graphs and images that are obscure to a non-specialist. Therefore, only a doctor can correctly evaluate it. Contact a specialist to clarify the diagnosis, prescribe additional methods of research and treatment.

Video on the topic "Holter-ECG"

Indications
Contraindications
Preparation and monitoring process
Deciphering the results
Complications of monitoring

The work of the heart muscle is based on the conduction of electrical impulses through it, causing the contraction of muscle cells. This phenomenon was studied and formed the basis for the registration of various heart diseases using a device called an electrocardiograph - an apparatus for recording an electrocardiogram (ECG). In the presence of pathological processes in the heart, ECG changes characteristic of certain diseases (CHD, arterial hypertension, and others) are detected.

But not always a complete picture of a particular disease can be obtained by performing only standard electrocardiography, since there are latent (hidden, “silent”) forms of heart disease that do not manifest themselves clinically and are recorded on the ECG during physical exertion. For the diagnosis of such forms of diseases, an ECG with physical activity (treadmill test, bicycle ergometry), as well as 24-hour Holter ECG monitoring are used.

Daily ECG monitoring- This is an instrumental method for diagnosing diseases of the cardiovascular system, based on the registration during the day of electrical activity that occurs during the activity of the heart muscle (myocardium) and varies depending on the presence of certain heart diseases in the patient.

The essence of this method, developed by the American scientist Holter, is as follows - the patient, as prescribed by the doctor, is placed on the chest with electrodes that read information about the work of the heart and are connected to a portable device in which the received data is processed and recorded in the form of graphic curves - electrocardiograms, stored in the device's memory. If a cuff is applied to the patient's shoulder at the same time (an analogue of a conventional apparatus for measuring blood pressure - a tonometer), then in this case monitoring allows for the dynamics of blood pressure measurements per day using an oscillometric (electronic) method.

In diagnostically unclear cases, the study can be extended up to seven days, if during the first 24 hours there was no successful registration of pathological changes on the ECG, and the patient continues to be disturbed by the symptoms for which the examination was prescribed.

Device for Holter ECG monitoring

Holter ECG and blood pressure monitoring has a number of advantages over standard ECG and exercise ECG, since with a single ECG performed at rest and lasting several minutes, it is not always possible to register myocardial ischemia or paroxysmal (paroxysmal) arrhythmias. The method also allows ECG recording in a state of normal household activity, with physical activity habitual for patients, which is important for correcting the treatment of patients who experience deterioration in heart function with minimal activity. In addition, we can note the availability of the method, simplicity in the study, non-invasiveness (no damage to body tissues).

Indications for Holter monitoring

This research method is used in the following cases:

1. Diagnosis of coronary artery disease (ischemic heart disease)
Prinzmetal's angina (vasospastic)
- painless ("silent") myocardial ischemia,
- stable and unstable angina pectoris,
- previous myocardial infarction, especially its painless form
- post-sudden cardiac death
2.

agnostic of arterial hypertension
3. Diagnosis of cardiac arrhythmias
- sick sinus syndrome
- Wolff-Parkinson-White syndrome (WPV - syndrome),
- Long QT syndrome
- atrial fibrillation,
- AV - blockade, sinoatrial blockade,
- ventricular tachycardia
4. Heart defects
- for the diagnosis of rhythm disturbances, often accompanying acquired heart defects, especially mitral valve defects
5. Scheduled examination
- persons subject to surgical intervention on the heart and other organs
- patients with diabetes mellitus (diabetic angiopathy - pathology of blood vessels, including coronary ones)
6. Monitoring the effectiveness of treatment
- antiarrhythmic and antianginal (with angina pectoris),
- cardiac surgery for coronary artery disease (stenting of the coronary arteries, aorto-coronary bypass grafting) and for arrhythmias (radiofrequency, laser ablation - destruction of additional pathways in the heart, installation of an artificial pacemaker and monitoring its effective operation),
- prescribing and evaluating the effectiveness of antihypertensive (lowering blood pressure) drugs.

Holter monitoring may be ordered if the patient develops the following symptoms:

- pressing or burning pains behind the sternum and in the region of the heart, with or without irradiation (radiating under the left shoulder blade, c.

fainting states.

Contraindications for daily monitoring

There are currently no contraindications for the study. But in some patients, the study may not be technically feasible, for example, with severe chest injuries, extensive wound or burn surfaces on the skin of the chest, with a very pronounced degree of obesity.

Preparing the patient for Holter monitoring of blood pressure and ECG

The patient does not need to prepare for this study. On the eve, you can take food and liquid in the usual quantities, in the morning before the procedure, a light breakfast is allowed. Alcohol and coffee should be avoided, as well as the number of cigarettes smoked, as these products can have a significant impact on the function of contractility and conduction of the heart muscle.

How is the research done?

The patient can be referred for the procedure both from the polyclinic and from the hospital department in which at the time of the examination he is on inpatient treatment (from the department of cardiology, endocrinology, surgery, etc.).

but in the morning the patient comes to the department of functional diagnostics, he is invited to go to the office, where the doctor instructs about the upcoming study. Next, the patient is placed on the skin of the anterior chest wall with electrodes (5-7 depending on the model of the device) using disposable stickers resembling an ordinary adhesive plaster. These electrodes are connected to a portable device worn on the chest or waist. In the case of a bifunctional (double) study, when ECG monitoring is carried out together with blood pressure, a cuff is applied to the patient's shoulder, also connected to the device. The entire installation procedure takes no more than 10 minutes, without causing discomfort.

Next, the patient is given a diary, where on the form in the form of a tablet it is necessary to note the time and actions performed at that time, as well as pain or other uncomfortable sensations. That is, the patient must record everything that happens to him in a day - sleep, eating, walking, physical and psycho-emotional stress, work, rest period. It is mandatory to record the time of taking medications, as this is important for the doctor in terms of the effect of a particular drug on heart function. During the study, you can not take a shower or bath, as contact of the device and electrodes with water is unacceptable.

A day later (or several days, depending on the doctor's prescription), the patient comes back to the same office, where the doctor peels off the electrodes from his chest, removes the cuff and takes the portable device, connects it to the computer and receives all the information already analyzed by the device itself. The doctor evaluates the received data and issues a conclusion, which should be transferred to the attending physician as soon as possible for subsequent correction of the treatment, if necessary.

After receiving the results, the patient can go home (if the data obtained did not reveal serious disorders in the work of the heart, requiring immediate hospitalization in a hospital) or to the department from which he was sent for examination.

Interpretation of the results of daily monitoring

What will the patient read in the received study protocol? In addition to the above electrocardiograms and their brief descriptions, a conclusion is printed in the form, which indicates the following parameters:

- type of monitoring - ECG, blood pressure, or both together
- the total number of heart rate (HR) - reaches about a hundred thousand or more per day
- sinus or non-sinus (with atrial fibrillation, atrial flutter, for example) rhythm
- maximum and minimum heart rate per day
- average daily heart rate and its type (tachy-, normo-.

high load - high, medium or low
- rhythm disturbances are described if they are detected, for example, ventricular or supraventricular extrasystoles, single, paired or group, tachycardia runs are indicated, if any
- describes changes in the blood supply to the myocardium, for example, violations of repolarization processes, or episodes of elevation or depression (decrease) of the ST segment - signs of myocardial ischemia, at what time they occur and whether they are associated with exercise, whether they were accompanied by pain, shortness of breath or other subjective signs.

Are there any complications during monitoring?

No, the examination procedure is absolutely safe for the patient, so there are no complications.

Therapist Sazykina O.Yu.

www.medicalj.ru

What does Holter monitoring show?

In the diagnosis of cardiovascular diseases, the ECG is of great importance. The only drawback of this method, which complicated the diagnosis of pathologies, was considered the impossibility of monitoring the work of the heart for a long time. It was managed to be eliminated by the American Norman Holter in 1961, who invented a portable cardiograph, which was named after the talented scientist.

The modern "Holter" is a small device that allows you to wear it on the body without any visible inconvenience. 24-hour Holter ECG monitoring is a continuous monitoring of the work of the patient's heart muscle in his usual environment. With its help, the doctor fixes the symptoms of the pathology that has arisen and establishes its cause. This type of diagnosis is carried out in different ways:

Detailed recording of the patient's heart rate for several days, which registers about 100,000 heartbeats.
With the help of a subcutaneous implant, a multi-month large-scale registration is performed.
Episodic assessment of the work of the heart during physical exertion on the body or pain in the chest. In this case, the operation of the device is carried out by pressing the button by the patient himself.

Holter monitoring - transcript

Decoding of Holter ECG monitoring is performed by a special computer program installed in clinical decoders. The initial stage of electroclassification is carried out by the device itself during operation. All the data recorded by the device, the cardiologist enters into the computer, makes corrections and writes out a conclusion. After deciphering and careful analysis of the monitoring results, the patient receives a detailed conclusion and a referral for treatment, if necessary.

The description of monitoring results is carried out according to the following parameters:

the type and type of observation are indicated;
the total frequency of contractions of the heart muscle for the entire observation period;
describes the type of heartbeat: normal, rare or rapid;
heart rate during exercise and at rest;
the presence of arrhythmias, if any, and other disturbances in the work of the heart are noted;
the number of cases of tachycardia and their possible connection with physical or psychological stress is recorded;
changes in the end section of the ventricular complex;
changes in PQ and QT intervals.

Holter monitoring is the norm

Only a qualified specialist can correctly assess normal function or identify myocardial pathology. According to the diagnostic results, the state of the heart muscle, the sufficiency of its blood supply or the presence of oxygen starvation are determined. The norm is sinus rhythm of the myocardium and heart rate within 85 beats per minute. Daily monitoring of the heart rate is used for suspected coronary heart disease.

Signs of this disease appear with a decrease in the conductivity of the coronary arteries. In this case, the "holter" registers depression of the ST segment. The ischemia index with Holter monitoring is a decrease in ST to 0.1 mV. Examination of a healthy heart will show a different picture: in the absence of coronary artery disease, it is considered normal to raise this area to 1 mm.

Holter monitoring system

Many cardiovascular diseases in the initial stage do not cause specific symptoms. The patient may feel discomfort in the chest area only during active life or at night. Failure of the heart rhythm (arrhythmia), which is characterized by inconstancy, is very difficult to detect in the process of conducting a conventional electrocardiogram in a clinic setting.

In such cases, the system of Holter ECG monitoring comes to the aid of cardiologists, which describes the work of the myocardium during the day. Modern devices differ from the first samples in small size and weight, which allows the patient to lead a normal life. All initial data have the utmost accuracy and reliability, which significantly speeds up the clarification of the cause of cardiac pathologies.

Application of electrodes for Holter monitoring

A mobile electrocardiogram is performed by a recorder that records heart rate readings using disposable electrodes. The Holter monitoring device itself is battery operated and is located on the patient's belt in a special case. Devices for continuous monitoring of the work of the heart muscle, depending on the model, receive from 2 to 12 independent ECG channels and are equipped with a cable with 5, 7 or 10 branches to which the electrodes are attached. They are fixed on the patient's chest with a patch in places with the least amount of adipose tissue.

During the examination, it is supposed to use a special gel, which helps to increase the electrical conductivity of the body surface. Skin areas and metal parts of the electrodes are pre-treated with a cleaning solution and degreased. All these manipulations are performed by qualified specialists in the clinic.

Holter monitoring of ECG and blood pressure

In some cases, the patient needs a double study. In addition to monitoring the function of the myocardium, the doctor has the opportunity to track the dynamics of the patient's blood pressure. 24-hour ECG and BP Holter monitoring is prescribed to confirm or refute a preliminary diagnosis, for example, with coronary artery disease.

Holter ECG monitoring is a permanent graphic recording of myocardial contractions, which is one of the two main diagnostic methods for various diseases of the cardiovascular system. It is considered the most effective in detecting arrhythmia and a latent form of myocardial ischemia. Very often these diseases are accompanied by arterial hypertension or hypotension.

Holter pressure monitoring

This method involves placing a cuff on the patient's upper arm, which is attached to the device and measures blood pressure in parallel with the electrocardiogram. Sometimes the failure of the heart rhythm directly depends on the “jumps” in blood pressure at certain times of the day or as a result of physical or emotional stress. Holter blood pressure monitoring helps to establish this connection, find and eliminate the cause of the pathology.

Holter monitoring - how to behave?

Patients who are scheduled for 24-hour Holter monitoring should properly prepare for it. There is no particular difficulty in such preparation. A few important aspects to pay attention to:

Before starting the procedure, it is important to take a bath or shower, as the device must not be exposed to water.
There should be no metal products on clothes and on the body.
It is important to tell your doctor about any medications you are taking if they cannot be discontinued.
It is necessary to provide the specialist with the results of the tests and other diagnostic methods.
It is necessary to inform the medical staff about the presence of a pacemaker, if any.
Do not focus on the device that you will wear throughout the day, as this may affect the results of the examination. Excessive emotionality will not do any good. Try to spend this time as in ordinary days, doing the usual things.

Holter monitoring - what not to do?

24-hour Holter ECG monitoring is a useful and necessary diagnostic method that requires the patient to adhere to certain rules:

Do not use electrical appliances (toothbrush, razor, hair dryer, etc.).
Stay away from microwaves, metal detectors and magnets.
X-ray, ultrasound, CT or MRI must not be taken during monitoring.
Sleep on your back at night so that the device is not exposed to mechanical stress.
Do not wear synthetic underwear and outerwear.

Diary of Holter monitoring

Holter heart rate monitoring is not limited to wearing the device. During the procedure, the patient keeps a diary in which he notes:

working hours and occupation;
time and type of rest;
list of foodstuffs and drinks;
housework;
physical exercise;
emotional condition;
duration and quality of sleep;
taking medications with an indication of the exact time; this aspect is very important if Holter monitoring of blood pressure is carried out in parallel;
the presence of unpleasant or painful sensations in the region of the heart, dizziness, fainting, headache, etc.

After the examination is completed, the device is removed from the patient. The data of the registrar and entries from the diary are placed into a computer for processing, and then the cardiologist makes adjustments and writes out a conclusion.

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Holter ECG monitoring and its varieties

Holter ECG monitoring can be recommended in many cases, children, adults at any age are exposed to it. Often, even if the patient complains of heart palpitations, repeated dizziness or loss of consciousness, the doctor will prescribe a procedure to confirm or refute the diagnosis and development of ischemic myocardial disease, arrhythmias.

Holter ECG monitoring is also prescribed for:

the patient was diagnosed with arterial hypertension for the first time;
diagnosis of white-coat hypertension;
heart defects;
hypertension of moderate or severe form, not amenable to treatment;
transferred myocardial infarction;
there is an acute heart failure or a chronic form of the disease;
it is necessary to control the work of the pacemaker;
there is a disease of the endocrine system or the patient has obesity.

In order for the Holter ECG monitoring to give the correct results, it is necessary to prepare for the procedure, which lasts continuously for a day or several days.

It is mandatory to take a shower, as during the procedure you will not be able to remove the equipment. You should also get rid of any metal accessories (jewelry, watches, etc.), as metal can affect the accuracy of the readings and the operation of the device.

Tell your doctor about any medications you have taken in the recent past, as many of them can affect the heart.

If you have recently had a routine ECG, then show the results to your doctor before monitoring.

To date, a Holter examination is considered the best and most informative, and therefore ECG monitoring is used even when a person simply needs to conduct a general diagnosis of the body and his health. Daily monitoring of the state of the heart rhythm with a recorder helps to make an accurate diagnosis.

Holter ECG is carried out in two versions - daily full-scale or fragmentary.

A fragmentary study is prescribed when the patient begins to have arrhythmia. As soon as the patient feels discomfort and worsening of his condition, he just needs to press a button on the equipment and it will begin to record all the data.

Holter ECG can also be carried out in continuous mode.

A full-scale daily study can last from 1 to several days. The indications of this examination will give a complete picture of the condition and functionality of the heart. With a standard cardiogram, the picture is two times less informative than with the Holter method.

During the procedure, in order for the Holter ECG study to give accurate results, the patient must be careful with the equipment: avoid water ingress, mechanical damage, avoid any contact of the equipment with those types of equipment that create a magnetic field around them.

On the recommendation of a doctor, an ECG holter may include a variety of tasks that allow you to identify various pathologies. For example, the patient will have to go up to the 5th floor and go down so that the doctor determines the level of his general health, as well as a disease that can be life-threatening.

Daily monitoring of the heart (ECG Holter): proper preparation and conduct

Daily monitoring of the heart begins with the preparation of the patient for the procedure. Be sure to take a shower so that in the process of diagnosis, a person does not experience discomfort. Cotton clothing is worn that does not interfere with air-water exchange.

Also, in the process of daily monitoring of the heart, the patient should avoid contact with equipment that can form around itself a magnetic field that adversely affects the operation of the holter device.

The holter device consists of two main parts - a stationary decoder and a mobile recording device that takes readings. The electrodes are always attached to the least mobile skin, which prevents the risk of equipment malfunction.

Daily full-scale monitoring of the heart takes readings of the heart when the patient leads a normal and familiar lifestyle, uses various physical activities, does physical exercises, runs and performs other activities.

Everything that the patient does when daily (1 or more days) monitoring of the heart is performed is also recorded in a diary, which indicates the type of action, the time it was carried out, and one's feelings. These are night sleep, meals, types of physical activity, medications, rest, stress, condition characteristics (deterioration or improvement, unchanged).

Holter monitoring of the heart is carried out taking into account the recommendations of the doctor and certain rules:

protection of equipment from moisture ingress so that data accuracy is not violated due to equipment breakdowns;
do not expose the equipment to temperature extremes, this is necessary for objective data of studies conducted in the conditions familiar to the patient;
holter heart monitoring will be accurate if during the diagnostic process, you will not experience vibrations, pressure drops (flying on airplanes, attraction);
compliance with the usual way of life without the risk of getting stress;
in the diagnosis of Holter, when monitoring the heart, you can not use higher physical activity than usual. First of all, because the data will be inaccurate, and also - the electrodes may move away from the skin.

Patients should rest on their back to avoid disturbing the position of the electrodes. In extreme cases, on the side, but make sure that the heart holter functions correctly.

This Holter diagnostic method is completely safe and heart monitoring does not cause any pathologies or serious conditions.

Daily ECG monitoring provides more extensive data on the state of the heart, any changes in its work under different conditions and actions. Thanks to this technique, which was developed by an American scientist a long time ago, it is possible to obtain data that a conventional cardiogram or examination by a doctor will never give.

In the course of a conventional electrocardiogram, a person is in a calm and relaxed state, and it is impossible to see changes in cardiac activity under conditions of excitement or physical activity. And this information can give a complete clinical picture of the development of the disease, any pathological changes that occur in the heart. Therefore, daily ECG monitoring is the most effective research method today.

The electrodes of the equipment are attached to the skin of the patient's chest, which will conduct correct observations and data recording. Often, 24-hour full-scale ECG monitoring is combined with blood pressure diagnostics and a cuff is also attached to the patient’s shoulder, which captures any fluctuations and changes in pressure.

As we have already noted, there are no negative effects on the patient's body and state of health during the study. The cardioregistrar does not cause any disturbances in the work of the heart. This daily (with different duration) ECG monitoring is prescribed for people at any age, with different suspicions of a diagnosis of heart disease.

Indications for applying monitoring of the heart rate during the day are complaints of patients about fainting and pre-syncope states, more frequent attacks of arrhythmia. The doctor prescribes diagnostics in the case when there is a suspicion of the presence of a pathology leading to death.

The risk group includes patients with high blood pressure, with a diagnosis of left ventricular dysfunction, with valvular heart disease, disorders. This also includes patients who are suspected of asymptomatic cardiac ischemia, variant angina pectoris, silent ischemia.

24-hour Holter ECG monitoring: interpretation of results and complications

24-hour Holter ECG monitoring will allow you to get an accurate and complete picture of the patient's heart condition, the changes that occur under different conditions.

After the end of the diagnostics, the data decryption stage begins. Previously, this procedure was carried out manually and took quite a long time. Today, with the availability of modern software, a complete analysis of the picture is carried out using a computer, and you will get the results very quickly.

All received signals from the device are processed automatically, and a graph of changes is displayed on the computer screen, according to which a diagnosis is made.

Due to the fact that the procedure is available to all patients, 24-hour Holter ECG monitoring allows you to make accurate diagnoses, notice pathological changes in the state of the heart, disturbances in its work in time, prescribe effective and adequate therapy that prevents the development of severe forms of diseases and complications.

In the standard set of received data, the following must be present:

sinus rhythm parameters;
data on cardiac arrhythmias;
conduction disorders of the heart;
violations that manifested themselves as a result of various actions of the patient;
dynamics of the ST segment.

Daily full-scale Holter ECG monitoring gives results that can solve a lot of problems that can arise with a negative state of the heart and violations of its functionality.

For example, a doctor will be able to assess all the risks that provoke heart disease in children and adults, in elderly patients, in those who have recently undergone surgery and are going to start their normal work activities.

Also, the study helps to identify all the difficulties that arise with cardiac arrhythmias against the background of heart diseases: cardiomyopathy, myocardial infarction, left ventricular dysfunction, etc.

Thanks to the Holter ECG, it is also possible to evaluate the effectiveness of therapy for various diseases and pathologies of the heart, and if the analysis of the data shows the treatment is ineffective, a different method of therapy is chosen.

Patients with a pacemaker are often examined to determine the performance of the equipment.

Today, daily or fragmentary Holter ECG monitoring helps to identify pathologies - tachycardia, atrial fibrillation, bradycardia and the prerequisites for the appearance of these anomalies. A double or triple rhythm, premature contractions, bigeminy, ventricular ectopia are also determined.

With an increased likelihood of arrhythmias against the background of loss of consciousness, they will be visible when processing the results of Holter monitoring in the form of sustained ventricular tachycardia, atrial fibrillation, in which a response rate of more than 180 beats per minute is observed.

Cardiac disorders that can pose a threat to the patient's life are determined by different types of arrhythmias:

paroxysms of ventricular tachycardia, in which the increase in rhythm occurs gradually and turns into ventricular flutter;
early ventricular extrasystole leading to tachycardia of the vulnerable period;
early, group or polytopic ventricular extrasystoles;
malfunctions of intraventricular conduction in acute forms;
short episodes of arrhythmia.

The study also helps to identify cardiac disorders, against the background of taking various antiarrhythmic drugs. The analysis is carried out according to such data as a 4-fold or 10-fold increase in the number of extrasystoles per day, as well as a manifestation of tachycardia, which was not previously observed in the patient.

Myocardial ischemia during examination is detected when the ST segment is elevated or depressed.

All the results obtained during Holter monitoring are purely individual and only a doctor who is familiar with the full clinical picture of the patient can make an accurate diagnosis.

The main tasks of diagnostics remain the identification and evaluation of cardiac arrhythmias, as well as the search for those areas in which ST segment shifts and fluctuations will be clearly expressed. As additions, the analysis of the duration of intervals in the heart rate, the work of the ventricles, and their activity are also evaluated.

A modern cardio recorder helps to get a complete and accurate picture of how the activity of the heart goes and to prevent the occurrence and development of serious conditions.

Today, Holter diagnostics is carried out in specialized cardiocenters and hospitals. The procedure is available and costs from 1500 rubles. The functionality of the research methodology helps to quickly go through this procedure without investing additional financial resources, changing lifestyle and other inconveniences.

The most important thing is to strictly follow the rules for using the equipment, not to create conditions under which failures in signal transmission may occur.

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Indications for carrying out

What symptoms are prescribed

Holter ECG monitoring is prescribed to a patient with the following symptoms:

This procedure is especially popular when the patient is worried about unpleasant symptoms, and the usual electrocardiogram and ultrasound of the heart showed no abnormalities.

For accurate diagnosis of arrhythmias

congenital heart defects (WPW syndrome, LGL syndrome, cardiomyopathy);
transferred myocardial infarction or multiple microinfarcts;
angina;
myocardial ischemia.

You can also diagnose other types of arrhythmias, for example, extrasystole.

To monitor the effectiveness of treatment

Daily monitoring of heart activity is prescribed to monitor the effectiveness of treatment (for example, after ablation of an additional pathway in WPW syndrome).

In addition, it is recommended to undergo a Holter examination after the installation of a pacemaker - to check whether it works correctly.

Preparation for the examination

No complex special training is required.

Also, tell your doctor if you are taking any medications.

How is Holter monitoring performed?

The procedure is very simple:

What to write in a diary

If your doctor has told you to keep a diary, you will need to write down the key moments of your day. Be sure to record the time:

Category	Examples
Passive rest and low physical activity	Watching TV, reading, needlework, studying, writing
Activities that may require emotional stress	Playing computer or gambling games, driving
Activities with light physical activity	Walk in the park, morning exercises
Average physical activity	Climbing stairs above 3 floors, light jog
Intensive loads	Workout in the gym, jogging for more than 20 minutes. Attention! Be sure to check with your doctor if you can perform this kind of action during daily ECG monitoring. In addition, make sure that the electrodes do not come off during the exercises and the data recording device is not damaged.

Be sure to record the time when activities from one category change to activities in another category.

If during the period of the study you felt any unpleasant symptoms (dizziness, palpitations, and others), be sure to list them in a diary and write down the time.

Rules for the patient

In order for the results of daily monitoring of the electrical activity of the heart to be as accurate as possible, certain rules must be followed:

Wear tight clothing made from natural fabrics. It is better not to wear loose clothing, as the electrodes can peel off from the body in it. And synthetic fabric can become electrified, which will distort the readings of the device. There should be no metal elements on clothes above the waist.
Do not overcool or overheat the device.
Do not allow water or other liquid to come into contact with it.
Do not place it on vibrating surfaces.
Do not stay near electrical equipment or transformer boxes.
Do not use your laptop or mobile phone for more than 3 hours a day. Do not bring the gadget closer than 30 cm to the device for Holter ECG monitoring. Do not get close to a working microwave oven.
Do not sit or lie down on the device. Lay it so that it won't be crushed while you sleep.
Make sure that the electrodes do not come off.
Do not undergo physiotherapy procedures and do not take x-rays during the examination.
Ask your doctor ahead of time if you can exercise during your exam.

Decrypted data

On the results sheet, you will see the following indicators.

Indicator	Norm
Average heart rate during the day	60–100 beats per minute
Average heart rate at night and during daytime sleep	41–81 bpm
Daily heart rate chart	Changes when changing activities
Number of supraventricular extrasystoles	Up to 960 supraventricular extrasystoles per day (up to 40 per hour) A slight excess of the norm (up to 1200 pieces per day) does not pose a threat to life and health
Number of ventricular extrasystoles	Absolute norm - 0 Permissible quantity that does not threaten life and health is 200 pcs. per day
The duration of QT and PQ intervals and the schedule of their changes.	QT interval norm: 340-450 ms (0.34-0.45 s) for women and 340-430 ms for men PQ - 120-200ms

Note! The norms indicated in the table are averaged and do not take into account the age and individual characteristics of the organism. Find out about the norm for you personally from your doctor.

Click on photo to enlarge

Contraindications and side effects

Holter monitoring is a completely painless procedure.

Has no contraindications. It can be used, including during pregnancy and breastfeeding, as well as in the elderly and children.

Does not cause side effects.

24-hour Holter monitoring is a diagnostic electrocardiography procedure in which the electrical activity of the heart is recorded throughout the day using a portable device.

This diagnostic method is prescribed by a heart disease specialist: a cardiologist or arrhythmologist.

Indications for carrying out

What symptoms are prescribed

Holter ECG monitoring is prescribed to a patient with the following symptoms:

pain and burning in the chest;
increased heartbeat;
dizziness;
dyspnea;
fainting or pre-fainting states.

This procedure is especially popular when the patient is worried about unpleasant symptoms, and the usual electrocardiogram and ultrasound of the heart showed no abnormalities.

For accurate diagnosis of arrhythmias

congenital heart defects (WPW syndrome, LGL syndrome, cardiomyopathy);
transferred myocardial infarction or multiple microinfarcts;
angina;
myocardial ischemia.

You can also diagnose other types of arrhythmias, for example, extrasystole.

To monitor the effectiveness of treatment

Daily monitoring of heart activity is prescribed to monitor the effectiveness of treatment (for example, after ablation of an additional pathway in WPW syndrome).

In addition, it is recommended to undergo a Holter examination after the installation of a pacemaker - to check whether it works correctly.

Preparation for the examination

No complex special training is required.

Also, tell your doctor if you are taking any medications.

How is Holter monitoring performed?

The procedure is very simple:

The patient undresses to the waist.
At the place of attachment of the electrodes, the hair is shaved and the skin is degreased with alcohol.
Special disposable electrodes (similar to those used in a conventional ECG) are attached to the body.
A battery-powered device is attached to the electrodes by wires, which registers the electrical activity of the heart throughout the day and saves it to the built-in memory. It can be fastened to the patient's body using a special belt or fixed in another way for the convenience of the subject (so that you do not have to carry it in your hands or in your pocket).
With the device, the patient leads his normal life. Sometimes the doctor may ask the patient to do some physical exercise during the Holter monitor. This is necessary in order to assess the reaction of the heart to stress and its recovery after them. Also, the doctor may ask you to keep a diary in which the subject writes down what and at what time he did during the day and when he went to bed.
A day later (this is the minimum examination period, sometimes the doctor may prescribe a longer ECG monitoring - up to 7 days), the patient comes to the clinic to remove the device.
At the end of the procedure, disposable electrodes are peeled off and discarded. A specialist connects the device to a computer. Then it views and decrypts the received data.

What to write in a diary

If your doctor has told you to keep a diary, you will need to write down the key moments of your day. Be sure to record the time:

taking medications;
food intake;
sleep (both night and daytime, if any);
emotional stress, if any;
activities of different activity (be sure to record the exact moment of changing activities of different activity, the time of their change can be recorded approximately).

Attention! Be sure to check with your doctor if you can perform this kind of action during daily ECG monitoring. In addition, make sure that the electrodes do not come off during the exercises and the data recording device is not damaged.

Be sure to record the time when activities from one category change to activities in another category.

If during the period of the study you felt any unpleasant symptoms (dizziness, palpitations, and others), be sure to list them in a diary and write down the time.

Rules for the patient

In order for the results of daily monitoring of the electrical activity of the heart to be as accurate as possible, certain rules must be followed:

Wear tight clothing made from natural fabrics. It is better not to wear loose clothing, as the electrodes can peel off from the body in it. And synthetic fabric can become electrified, which will distort the readings of the device. There should be no metal elements on clothes above the waist.
Do not overcool or overheat the device.
Do not allow water or other liquid to come into contact with it.
Do not place it on vibrating surfaces.
Do not stay near electrical equipment or transformer boxes.
Do not use your laptop or mobile phone for more than 3 hours a day. Do not bring the gadget closer than 30 cm to the device for Holter ECG monitoring. Do not get close to a working microwave oven.
Do not sit or lie down on the device. Lay it so that it won't be crushed while you sleep.
Make sure that the electrodes do not come off.
Do not undergo physiotherapy procedures and do not take x-rays during the examination.
Ask your doctor ahead of time if you can exercise during your exam.

Decrypted data

On the results sheet, you will see the following indicators.

A slight excess of the norm (up to 1200 pieces per day) does not pose a threat to life and health

Permissible quantity that does not threaten life and health is 200 pcs. per day

Note! The norms indicated in the table are averaged and do not take into account the age and individual characteristics of the organism. Find out about the norm for you personally from your doctor.

Click on photo to enlarge

Contraindications and side effects

Holter monitoring is a completely painless procedure.

Has no contraindications. It can be used, including during pregnancy and breastfeeding, as well as in the elderly and children.

Does not cause side effects.

What can not be done with Holter monitoring?

The research method called "Holter monitoring" in medicine has been used since 1961. In modern diagnostics of heart diseases, it has become widespread, however, in order to obtain objective results, the patient must know what cannot be done with Holter monitoring.

This technique helps to determine if there are any changes in the work of the heart. This study, which consists in continuous recording of the electrocardiogram, is carried out from 12 hours to two days.

Advantages of the method

The method has a number of advantages over the standard ECG:

makes it possible to evaluate the work of the patient's heart both at rest, and most importantly - in the conditions of daily physical activity;
the slightest changes that appear occasionally will not escape the attention of the doctor, since the ECG recording takes place over several hours.

When can a doctor prescribe a holter?

Holter procedure is indicated in cases where:

the patient complains of palpitations, he has a loss of consciousness or dizziness;
it is necessary to confirm or exclude cardiac ischemia;
there was a need to monitor patients with threatening ischemia and arrhythmias;
it is necessary to determine whether the prescribed treatment gives positive results;
the patient is diagnosed with white-coat hypertension (a blood pressure monitor is recommended);
the patient has been diagnosed with arterial hypertension for the first time;
moderate to severe hypertension is observed, which is resistant to the treatment;
diagnosed with heart disease;
the patient has had a myocardial infarction;
the patient has a pacemaker, the work of which should be monitored;
there is acute or chronic heart failure;
the patient is overweight or has endocrine diseases (in addition, hormonal studies may be prescribed).

How to prepare for Holter monitoring?

In patients to whom the doctor prescribes this study, a completely logical question arises: “How to prepare for the Holter?” No special measures are required, however, some conditions must be met, but you should not worry, as preparing for the Holter will not take much time.

You should take a shower before the study, as this will not be possible during the monitoring.
Remove all metal jewelry; there should also be no metal elements on clothing.
Inform the doctor about the medicines that are prescribed for daily intake.
If there are results of previously conducted ECG, they must be shown to the doctor.

This completes the preparation for Holter monitoring.

To make an accurate diagnosis, the doctor may additionally prescribe other examinations. Details here. In some cases, MRI is necessary for violations of the cardiovascular system. Read in this article.

How is the procedure carried out?

Some patients are reluctant to agree to monitoring because they do not know how a holter is made. Everything is very simple. The nurse sticks electrodes to the patient and hangs up the device. Then he gives out a diary so that the patient can make notes for the doctor.

In the diary, it is necessary to record the beginning and end of such moments:

Holter monitoring: what is strictly forbidden to do

There are some restrictions that must be introduced into the usual way of life if this examination is performed:

Do not allow liquid to come into contact with the device. One patient who was being tested in the hot summer broke down and decided to freshen up a bit. As a result of water ingress on the device, the examination had to be interrupted.
Do not overcool or overheat the device. The study must be carried out at medium temperatures for objective results.
Protect the device from mechanical damage and vibration.
Do not allow the device to come into contact with products that have increased chemical activity.
Expose the body to great physical exertion. So, a young guy during the examination gave a big load, which caused inaccurate results, and there was also a detachment of the electrodes.
It is unacceptable to be near equipment that runs on electricity, as well as near transformer booths during monitoring.

How to behave during Holter monitoring? Here, too, there are some limitations:

you need to sleep on your back or, in extreme cases, on your side, since when turning over on your stomach, the electrodes can move;
wear clothes made from natural fabrics, preferably cotton or linen.

Can any complications occur after monitoring?

This method of examination does not cause absolutely no complications in a person. Current does not pass through the electrodes, they are needed in order to “catch” weak electrical cardiac potentials.

results

The results are analyzed by a cardiologist. He will definitely compare them with the previous ones, take into account the patient's complaints. Re-monitoring is possible if the results are not entirely clear.

This examination is effective only when the patient complied with all of the above rules.

Holter monitoring: what not to do

Holter monitoring, which cannot be done in this case will be described below, is a special device (recorder) connected by wires to electrodes, also, when checking blood pressure, the device is equipped with a cuff that pumps air on its own. Works without recharging, on batteries.

The device is named after the biophysicist Norman J. Holter, who in 1947 created a permanent record of the electrocardiogram. True, this device was a large and uncomfortable box that weighed about 40 kg. In 1961, the device, which already weighed about 1 kg, flew around the pages of all medical literature and gained popularity and wide application in medicine.

The doctor prescribes monitoring to the patient when he wants to see a detailed picture of the myocardium, find out the cause of the problem and give accurate recommendations for treatment. Also, the doctor sets the period of wearing the device.

Holter monitoring is often used for arrhythmia, myocardial ischemia, arterial hypertension, hypotension, as well as:

in violation of the heart rhythm;
with a feeling of seizure in the region of the heart, interruptions in work both during wakefulness and during sleep;
with pain in the thoracic region of the body associated with physical or emotional stress;
with dizziness and fainting;
with jumps in blood pressure;
with myocardial infarction (less than six months);
with hypertrophic cardiomyopathy;
in the diagnosis of vegetative disorders not associated with physical or psychological stress;
depending on the weather;
with suspicion of angina pectoris;
when evaluating the effectiveness of drug treatment;
when checking the operation of the pacemaker.

The registrar helps to recognize changes in the heart system, as a conventional electrocardiogram performed in a clinic or hospital cannot do, since this device can work continuously for several days, being directly on the human body, even during sleep and capture up to one hundred thousand heart beats.

The Holter device has no contraindications, unless the patient has skin problems in the area where the electrodes are attached. It can be burns or injuries of the chest, it is also not advisable to use it if a person is overweight. If the patient has no contraindications to the use of the device, some rules must be followed during the Holter monitoring procedure.

What can not be done, and what can be listed below:

Do not come into contact with magnets, electronic equipment (X-ray, magnetic resonance tomography), metal detector, transformer boxes and is located near power lines.
During the procedure, it is better to avoid water procedures.
It is not recommended to overheat or, on the contrary, supercool the device.
Protect the device from strong vibration or any mechanical damage.
Try not to overload yourself with physical activity, this will lead to profuse sweating, which contributes to the detachment of the electrodes.
It is advisable to use loose cotton clothing.
The patient during the examination period should refrain from smoking, drinking alcohol, drinking coffee and wearing metal jewelry.

Holter installation and how to sleep with it

Holter installation is carried out under the supervision of doctors, who distinguish between several common types of monitoring.

Fragmentary - used for rare attacks of arrhythmia. The patient, who feels changes in his condition for the worse, turns on the device on his own, which records the data on the recorder. Also, this method can be used in the long run.

Today, in medicine, for a fragmented type of monitoring, compact devices are increasingly used. They are very light, small and easy to use.

The device fits in a pocket like a phone or is worn like a wristwatch. If the condition worsens, the person easily places the device on the chest and activates the device.

Full-scale - works up to three days. During this time, up to one hundred recordings are made per recorder, which is twice the number of recordings made on a conventional electrocardiogram.

There is another type of monitoring - super-long. Holter is installed in the form of a programmed subcutaneous implant, which works for about two years.

Various types of monitoring equipment are used:

3-channel devices - are the most common, which record the rhythm and conduction;
12-channel recorders capture the state of the myocardium (which enriches the heart muscle with oxygen). Used to diagnose coronary heart disease, this method detects attacks of short-term ischemia.

Installation of the device does not require special technological processes. The patient should bathe, remove the hairline on the chest at the places where the electrodes are attached, the skin in these places should be clean and degreased with alcohol (performed directly in the medical office), 5-7 electrodes are installed using a special gel, additionally fixing with adhesive tape.

The registrar has a very small weight (modern devices weigh up to 500 grams), which can be placed in a special case, hanging it on your shoulder or attached to a trouser belt. When the device is installed, recording starts. It is not advisable to touch the device without the advice of a doctor or nurse.

Together with the installation of the device, the patient is given an observation diary where it is necessary to record everything that happens to him during the day, up to the minutes of each of his actions.

For example, the time of awakening, daytime and nighttime sleep, breakfast, lunch, dinner, medication, physical education, any changes in the psychological state (excitement, anxiety, joy, sadness), as well as watching TV. And how to sleep with a holter should tell the doctor.

It is necessary to ensure that the electrode is firmly attached to the body. When the electrode is shifted, it must be glued into place. This will significantly affect the results of the research. After the daily procedure, the device is returned to the doctor for examination of the records and interpretation of the data. Data analysis takes place during the day.

Analysis and interpretation of data is carried out using a computer with special software. The doctor compares the data from the recorder and the observation diary. There are, as in any automatic device, errors that are corrected by a specialist doctor. The next day, the patient receives a doctor's report and further recommendations.

How to deceive a holter and why it may be needed

How to cheat holter? Some people ask this question, but it is impossible.

The patient, while wearing the device, can carry out his life activities as usual. But at the same time, follow some of the doctor's recommendations: an additional load in the form of physical exercises (running, squats, walking up the stairs).

It is advisable to sleep on your back, as sleeping on your stomach can move the electrodes, which can affect the recorded data. There is one "but".

When using the device, it is better to stock up on a certificate from a doctor about the installation of the device in order to avoid questions from police officers who may inadvertently mistake you for a terrorist.

Why is a Holter test performed? In order to identify problems in the work of the heart and the cardiovascular system as a whole. To do this, you just need to fill out the diary correctly, write down everything that happens during the day, especially if you experience pain or pressure in the heart, palpitations, dizziness, weakness, fainting.

The cardiologist compares the data from the registrar and entries from the diary, in what period of time the rhythm may have been disturbed and under what circumstances.

The device cannot be fooled. No matter how hard the patients try to load themselves with physical activity in order to distort the results for the worse, and these are mainly draft-age guys because of their unwillingness to do military service, they will not succeed, since it is impossible to deceive the holter.

The device is equipped with a special sensor that captures the slightest changes, which, in turn, an experienced doctor can easily decipher and understand whether the patient is simulating or not. Or another example, quite the contrary, a patient can be removed from his activity due to deteriorating health (such are, for example, pilots, drivers) and deliberately distorts the data. But health is no joke.

Remember that self-medication is dangerous for your health! Be sure to consult with your doctor! The information on the site is presented for informational purposes only and does not claim to be reference and medical accuracy, is not a guide to action.

Holter heart monitoring - how is the procedure performed and what does it show?

A Holter study is a long-term record of the work of the heart, a cardiogram. Holter monitoring of the heart is a comprehensive approach that includes electrophysiological and instrumental diagnostics, which is also called ambulatory ECG monitoring.

Holter monitoring - what is it?

A special Holter device is attached to the patient, thanks to which it is possible to monitor the work of the patient's heart for a long time, which is not possible with a conventional electrocardiogram. Holter examination diagnoses the work of the myocardium, determines the pressure drops, reveals various pathologies in the work of the heart for 12-72 hours. If necessary, monitoring can be longer.

Holter monitoring is much more effective than a cardiogram in controversial and complex cases, when it is possible to evaluate the work of the heart muscle only in dynamics over a long period of time.

The main benefits of this study include:

the ability to fix the work of the heart at rest, sleep, during physical exertion, emotional outbursts, etc.;
long-term study of the work of the myocardium;
the ability to fix even minor malfunctions in the work of the heart, which rarely manifest themselves and are noticeable only during a long study;
the possibility of emotional influence on the work of the heart is excluded.

When is Holter monitoring prescribed?

This type of study is prescribed for patients who need a complete diagnosis of myocardial function. Usually the doctor prescribes Holter in such cases:

the patient has complaints of pain in the heart and periodic failure of the heart rhythm, but no pathologies were detected on the ECG;
the patient periodically experiences attacks of tachycardia, accompanied by dizziness and / or fainting;
there is a suspicion of myocardial ischemia, but ECG data do not allow an accurate diagnosis;
it is necessary to monitor the work of the heart muscle in patients with atrial fibrillation or severe ischemia. The study makes it possible to assess the strength and frequency of heart contractions;
assessment of the work of the heart of patients who have suffered a myocardial infarction, have heart failure or heart disease;
tracking hypertension (sudden pressure drops) that cannot be treated;
assessment of the success of the prescribed treatment;
assessment of the work of the pacemaker installed in the patient.

How often do you need to conduct a study and why?

Sometimes people have a strong heartbeat, murmurs, arrhythmia or pain in the heart not all the time, but at a certain load or at a certain time of the day. An electrocardiogram may not reveal any abnormalities, as it can be carried out at a time when the patient's heart is in a calm state. An ECG can record from 3 to 20 heart beats and, based on this, the state of the heart muscle is assessed. On the same day, the heart contracts more than one hundred thousand times, and the Holter device allows you to fix any deviations that have manifested themselves during this period.

Holter ECG monitoring

Usually, one Holter monitoring is enough for diagnosis, but in rare cases, the doctor prescribes a second study if the first did not reveal the cause of the disease. Such monitoring is regularly prescribed for people with congenital heart anomalies and after a heart attack.

Important! The results of the Holter study will be true if the patient complied with all the doctor's instructions. Otherwise, the diagnosis will not be accurate.

Types of Holter Monitoring

Full multi-day study. Duration from 1 to 7 days. This type is the most common. During the study, the patient can move freely, the device captures all heartbeats. The probability of "missing" the signs of the disease is extremely small.
Large-scale long-term monitoring. It is performed using a registrar, which is implanted under the patient's code and captures the work of his heart for a long time, the duration of which ranges from 1 month to 1 year. The registrar captures data on the work of the patient's heart in different life situations, can be activated both by the patient himself and automatically. In this case, the patient is at home, and not on inpatient treatment, as in other cases.
Event (fragmentary) monitoring. It provides for the recording of an electrocardiogram at the moment when the patient experiences pain, discomfort and deterioration of well-being. At this point, the patient presses a button on the recorder, starting an ECG recording, which is then decoded by the attending physician. In some cases, monitoring is carried out continuously if the patient is in serious condition. Devices for event monitoring are not implanted under the skin, but are worn by patients all the time. The compact size allows you to wear the device as a bracelet or watch.

For high accuracy and reliability of the results, the patient needs to keep a diary in which he records the time when discomfort began and stopped. These recordings help the cardiologist correlate the data with the ECG results and make an accurate diagnosis.

Important: If the Holter study did not reveal any pathologies and cardiac arrhythmias, but the patient feels pain and feels unwell, additional diagnostics are necessary.

A full multi-day Holter study is carried out up to the 1st week and is the most common method.

Procedure safety

Numerous long-term studies have shown that the procedure is safe for human health, but there are some limitations. These include:

the patient during the study should not come close to very powerful electrical appliances, transformer boxes, electrical equipment and power lines;
do not allow any liquid to get on the holter device, otherwise it will be necessary to stop monitoring;
Too much exercise can lead to a significant change in heart rate, leading to incorrect data and misdiagnosis. Also, as a result of physical activity, the electrodes can move away;
the patient should wear clothes made from natural fabrics, since synthetic things create an electric field that can disrupt the operation of the device;
It is best for the patient to sleep on his back, in extreme cases - on his side. Sleeping on the stomach is contraindicated, as it can lead to the disconnection of the electrodes;
it is necessary to protect the device from hypothermia, overheating and direct sunlight, as well as mechanical damage and vibration;
do not allow aggressive chemical compounds to enter the device.

How is the procedure carried out?

At the stage of preparation for the study, the patient must take a shower, remove all metal objects from the body and inform the doctor about all the medicines that he takes. Before gluing the sensor, the skin is degreased with alcohol, sometimes you have to shave off your hair.

Sensors (from 5 to 12 pieces) are attached to the patient's chest, which are connected to the device. If the study is aimed at monitoring pressure surges, then a special cuff is put on the patient's arm. The entire sensor installation procedure rarely takes more than ten minutes. The study is most often performed on an outpatient basis, and after the end of the study, the patient can go home.

Before starting the Holter examination, the patient must take a shower and remove all metal products from himself.

After installing the sensors, the subject starts a diary in which he writes:

activities during the day: walking, talking, watching TV, eating, playing sports, mental work, etc.;
time allotted for rest and sleep;
the exact time when the condition worsened: shortness of breath, palpitations, pain in the heart, dizziness, etc.

The duration of monitoring is determined by the attending physician. Usually pathologies and diseases that threaten life are determined in the first 12 hours, less obvious problems require a longer study. So, extrasystoles in the ventricles are determined on average in 6 hours, tachycardia - yes, a day, a day is also needed to detect heart failures leading to fainting and dizziness. Three days are enough to detect heart block.

Contraindications to the procedure

Holter heart monitoring is an absolutely harmless procedure and has no contraindications. The exception is those situations where the study is physically impossible to conduct. This happens in cases where the patient has chest injuries, open wounds, burns. In this case, you will have to wait until the skin becomes intact. Obesity is also a hindrance to monitoring, as heart signals can be poorly captured due to the large layer of subcutaneous and internal fat. The expediency of Holter research in very obese people is determined individually by the doctor. In such cases, the diagnosis can also be made on the basis of an ECG, since shortness of breath and heart failure are often observed in obese people.

The Holter device is harmless to the elderly, children and pregnant women.

Holter study is absolutely safe for children

If a person has a pacemaker, then any study using electrical devices is prescribed to him very carefully. It is important to follow all safety rules during the procedure.

Holter examination is carried out for a fee, in contrast to the cardiogram, which can be done according to the doctor's testimony for free. On average, the price of a heart monitoring holter is 3,000 rubles per day of the study + the cost of installing the device. The price of long-term large-scale monitoring is set individually depending on the type of apparatus, the duration of the procedure, etc. It is necessary to carry out the procedure in licensed medical centers, in public hospitals with experienced doctors. Only a qualified cardiologist will be able to make the correct diagnosis and find the right solution.

It is important to remember that Holter monitoring is not exclusively a technique for diagnosing heart disease. Examination of the patient in case of complaints should be comprehensive, especially if different diagnostic methods show different results.

Holter monitoring of the heart: what is the Holter ECG used for?

Why Holter ECG is used and in what cases it is necessary - we will tell in this article.

What it is?

Holter monitoring of the heart (24-hour ECG monitoring) is a method of continuous recording of an electrocardiogram (ECG) for a day or longer using wearable cardio recorders (monitors).

The method got its name from the name of the scientist who first used long-term ECG recording in 1952.

What is the method used for?

Daily ECG monitoring reveals:

type of heart rhythm and heart rate;
rhythm disturbances (supraventricular and ventricular extrasystoles, paroxysmal arrhythmias, pauses);
ischemic ECG changes caused by coronary artery disease;
in some models, heart rate variability.

Daily ECG monitoring is used in the following situations:

diagnosis of arrhythmias in case of complaints of rapid or slow heartbeat, interruptions in the work of the heart, irregular pulse, episodes of dizziness, severe weakness or loss of consciousness, a feeling of cardiac arrest;
diagnosis of ischemia (oxygen starvation) of the myocardium in case of complaints of pressing, squeezing, burning pains behind the sternum, especially during exercise, before prescribing exercise tests, complaints of a feeling of "coma in the throat", heartburn, episodes of pain in the lower jaw or elbows;
control of the installed pacemaker;
monitoring the patient's condition in dynamics, including monitoring the effectiveness of treatment.

How to prepare for the procedure?

If you need to purchase batteries for the monitor, you need to pay attention to the markings. Batteries must be alkaline (alkaline), size AA ("finger") or AAA ("little finger").

If the adhesive plaster is poorly tolerated, it is advisable to purchase a special hypoallergenic silk-based plaster at the pharmacy. It will help avoid skin irritation.

How is the examination carried out?

The patient should sleep as usual, but not lying on his stomach.

When peeling off the electrodes, you need to attach them back.

Indications

Complaints about episodes of dizziness, loss of consciousness, heart rhythm disturbances.
Examination for myocardial infarction, hypertrophic cardiomyopathy, and other severe heart diseases.
WPW syndrome, long QT syndrome.
Suspicion of asymptomatic myocardial ischemia.
Suspicion of sleep apnea syndrome (a special program for the analysis of apnea is used).
Control of the pacemaker.

Contraindications

What to do after the study?

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1 COMMENT

Thank you for the article. At least he could, with the help of the article, decipher from the daily monitoring of the ECG Ventricular and supraventricular extrasystoles.

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