What Is Holter Monitoring?

Holter monitoring is a continuous recording of your heart rhythm, usually for 24 hours, while you go about your usual daily activities. It is especially useful in diagnosing abnormal heart rhythms.

What Does It Show?

An abnormal heart rhythm, called an arrhythmia, is a change in either the speed or pattern of the heartbeat. During an arrhythmia, the heart may beat too fast, too slowly, or irregularly.

An arrhythmia may be felt as a skipping or fluttering sensation in the chest (palpitations). It may also cause light-headedness, a fainting spell, chest pain, or shortness of breath.  Some arrhythmias, however, may go unnoticed.

Doctors can diagnose an arrhythmia by obtaining an electrocardiogram, or ECG, which is a recording of the heart's electrical activity. During a standard ECG test, the heart's electrical signals are recorded on a strip of moving paper.

Quite often, an arrhythmia will not occur during the brief period (less than a minute) of actual recording at the doctor’s office. If your doctor suspects you have an arrhythmia, he or she will want to record the ECG over a longer period of time.

Holter monitoring allows your doctor to record your ECG over a period of 24 hours or longer, while you go about your usual daily activities.

How Does It Work?

A Holter monitor is a small, portable recorder that is worn on a strap over your shoulder or at your waist. Three to five small, sticky patches, called electrodes or leads, are placed on your chest and connected to the recorder by thin wires.

The electrical signals of your heart are picked up by the electrodes and are then transmitted to the monitor. The device records the electrical signals, either on tape or on a memory card.

While wearing the monitor, you will be asked to keep a diary of your activities and symptoms. After the monitoring period, the doctor will compare the timing of your activities and symptoms with the pattern recorded on the ECG.

Why Is Hotter Monitoring Done?

Here are a few situations where Holter monitoring may be done:

• To detect arrhythmias that occur irregularly or only during certain activities.
• To evaluate symptoms (such as dizziness, fainting, or chest pain) of possible heart disease.
• To monitor how well arrhythmia treatments (such as medications or pacemakers) are working.
• To detect poor blood flow to the heart muscle, which may indicate coronary heart disease.

How Is the Test Done?

You are fitted with the monitor and electrodes by a technician at the doctor’s office or test center. Several areas on your chest are carefully cleansed with alcohol and an abrasive lotion, to ensure that the electrodes have good contact with the skin. Men may need to have areas of their chest shaved.

A FEW PRACTICAL TIPS

• For the test, wear a loose-fitting blouse or shirt, with the buttons in front.
• When sleeping, try to stay on your back with the recorder positioned at your side, so that the electrodes are not pulled off.
• Do not get the electrodes, wires, or recorder wet. Do not swim, take a bath, or shower while wearing the recorder.
• If one of the electrodes or wires comes loose, a light on the monitor will flash. Press on each electrode to try to restore contact. If you have difficulty, call your doctor or test center.
• While wearing the recorder, avoid electric blankets, magnets, metal detectors, and high-voltage areas such as power lines. Signals from such devices may affect the recording.

Next, the electrodes are placed on your chest and connected by wires to the monitor. It's very important that the electrodes and wires remain attached for the entire monitoring period. You will also be given a diary in which you will enter your activities and symptoms during the monitoring period (see page 6). You can then go about your normal daily activities while you wear the monitor.

 

Some monitors are equipped with an event marker. When you feel symptoms, you press the event marker button to mark the event on the ECG recording.

At the end of the recording period, you will return to the doctor’s office or test center to have the monitor and electrodes removed. Or, you will be shown how to remove them yourself.

Keeping a Diary

You will be asked to keep a diary during the period you wear the monitor. The diary is very important. It allows the doctors to correlate your activities and symptoms with the ECG recording.

The information you will need to write in the diary includes the following:

• Your activities (such as walking, climbing stairs, bowel movement, sexual activity, emotional upset, sleeping, taking medications, etc.).
• Symptoms you experience (such as palpitations, dizziness, fainting, chest discomfort, etc.).
• The exact time at which these events occurred

Halter Monitor Diary
Time	Activity	Symptom*
10:20 am 12:35 pm 1:50 pm 1:15 pm	walking 2 milcs having lunch meeting with client climbing stairs	racing heart, dizziness a few skip beats fluttering in the chest chest pressure

Your Test Results
After you return the monitor, the recorded data are played back, scanned, and analyzed by a computer.

The printed report is then reviewed by a doctor. Final results are usually available within a few days.

Your doctor will discuss the results of the test with you during a future office visit.

The results help the doctor accurately diagnose your condition and develop a treatment plan that's best for you.