Humza Khizer

Dive into the world of Holter monitoring and understand its purpose, procedure, and significance in monitoring heart health. Discover more on Meri Sehat.

What Is A Holter Monitor?

Introduction

During the late 1950s, Dr Norman Holter came up with an ambulatory electrocardiographic (ECG or EKG) system. While the idea was not essentially &ldquo;new&rdquo; &ndash; it was rooted in the work of Einthoven&rsquo;s string galvanometer &ndash; it revolutionised how cardiac rhythms could be tracked even outside of a hospital setting.

Einthoven, who was also the first person to coin the term &ldquo;electrocardiogram&rdquo; in 1893<a href="#accordion">[9]</a>, devised a galvanometer that was extremely sensitive in tracking the cardiac rhythm from outside the human body. Dr Norman, after whom the Holter device is named, decided to take it a step further &ndash; he made it portable enough so that the electrical activity of the human heart can be measured easily for 24-48 hours while going about the daily routine. 
&nbsp;

At the beginning, though, the Holter monitor was as big as a briefcase. It consisted of an amplifier, a tape recorder, electrodes, a playback unit, and an analysing unit. There used to be 10 electrogram leads; 6 standard precordial electrodes and 4 torso electrodes<a href="#accordion">[2]</a>.

However, with recent technological advancements, it is now a portable, battery-operated, non-invasive medical device that is frequently used to evaluate patients with suspected arrhythmias in the ambulatory setting<a href="#accordion">[1]</a>.&nbsp;It measures cardiac activity, including heart rate and rhythm but, more than that, it picks up and highlights irregular heartbeats, which indicate cardiac issues. 
&nbsp;

While a normal ECG test verifies the electrical activity of the heart for short periods only, a Holter test records for continuous long duration activity (12-48 hours). Thus, it allows more time for any abnormalities to be picked up. According to research, the diagnostic yield of 24-hour Holter monitoring for the examination of patients with palpitations is 15-39%<a href="#accordion">[1]</a>. 
&nbsp;

There are 3 types of Holter monitoring test:

<ul>
	<li>Wired (1-2 days)</li>
	<li>Patch (1-14 days)</li>
	<li>Wireless (3 days)</li>
</ul>

The medical care team decides on the most suitable test based on the patient&rsquo;s condition and preference<a href="#accordion">[4]</a>. 
&nbsp;

This is one of the most straightforward and fastest tests that is used to evaluate the heart activity: 
&nbsp;

<ol>
	<li>
	A doctor or a technician at a hospital will attach electrodes (i.e., small, plastic patches) to the skin.
	</li>
	<li>The electrodes will then be attached to the small, portable recording device by wires.</li>
	<li>The individual can perform daily activities (except shower or vigorous exercise) while wearing the monitor.</li>
	<li>The individual maintains a record of all the activities and symptoms for around 24-48 hours.</li>
	<li>Visit the doctor after 1-2 days to return the Holter monitor, discuss the results, and get the appropriate treatment plan to manage the symptoms observed. 
	&nbsp;</li>
</ol>

Note: The Holter monitor only measures, records, and prints electrical activity of the heart. It does NOT send any electricity into the body. There is no risk of an electricity shock. 
&nbsp;

<h5>The Patient Diary</h5>

This is one of the most important aspects of using a Holter monitor. When the doctor advises the Holter monitor test, they simultaneously instruct their patients to keep a track of all their activities during that time.

It&rsquo;s advised that the patients keep it simple so as not to feel any extra stress or burden. However, they should take care to note the time and specific symptoms they feel (e.g., light-headedness and shortness of breath) alongside the activity. This will help the cardiologist to compare it to the machine&rsquo;s readings. 
&nbsp;

When patients fail to maintain the accuracy of their experience, it&rsquo;s possible for the data to be misinterpreted by the doctor because they cannot confirm if the symptoms and tracing are related or if any abnormality exists. 
&nbsp;

Understanding the Basics of Holter Monitoring

A Holter monitor can be used for the evaluation of certain events such as:

<ul>
	<li>Chest pain during exercise</li>
	<li>Heart-related conditions, including tiredness, dyspnoea, dizziness, or fainting</li>
	<li>Palpitation</li>
</ul>

 
This helps the doctor to gauge whether the current activity has an impact on the heart or vice versa. 
&nbsp;

Additionally, a Holter monitor can be used to determine:

<ul>
	<li>Irregular heart rhythms that an ECG missed</li>
	<li>Cause of Arrhythmia (heart rhythm abnormalities) and/or palpitations.</li>
	<li>Any underlying heart condition that increases the risk of arrhythmias</li>
	<li>The efficacy of treatment for cardiac arrhythmias; for example, it can monitor abnormal heart rhythm after an operation and show if the prescribed medications are suitable for a patient&#39;s condition or not</li>
	<li>The cause of unexplained fainting&nbsp;</li>
	<li>Functioning of a pacemaker</li>
</ul>

 
The risk of future heart-related events in particular disorders; for e.g., a person can suffer from hypertrophic cardiomyopathy (thickened heart walls) following a heart attack 
&nbsp;

While the Holter monitor test can be performed at any time, it is preferably conducted at a time 
&nbsp;

<ul>
	<li>When the patient is not involved in any water-related activity or exercises that would drench them in excessive sweat because that&rsquo;s going to affect the reading. The skin has to stay dry while the Holter monitor is attached to it.</li>
	<li>When the patient is not travelling. This is to avoid airport security hassles because once the device is fitted, it needs to stay there at all times, even during sleep. 
	&nbsp;</li>
</ul>

<h5>Before The Test Procedure</h5>

It&rsquo;s best to:

<ul>
	<li>Take a shower</li>
	<li>Shave chest hair, if necessary</li>
	<li>Do not put any cream, lotion, oil, or powder on the chest</li>
	<li>Wear loose clothing 
	&nbsp;</li>
</ul>

<h5>During The Test Procedure</h5>

Patients need to ensure that they:

<ul>
	<li>Do all the regular chores while wearing the monitor</li>
	<li>Firmly attach the electrodes to the skin for accuracy</li>
	<li>Avoid taking shower, swimming, or indulging in any water activity, especially if it&rsquo;s wired Holter monitoring</li>
	<li>Avoid any sort of high intensity workout</li>
	<li>The small pouch bearing the Holter monitor is placed around the neck since it has to be near the chest for accurate readings</li>
	<li>Take care of their monitor while carefully recording any pain, discomfort or any cardiac symptoms as instructed by the medical care team. 
	&nbsp;</li>
</ul>

There is no risk reported as such. However, transpore or micropore tapes are often used to attach the electrodes during the procedure. Some people have allergic reactions to adhesives<a href="#accordion">[3]</a>.&nbsp;In that case, inform the cardiac technologist in advance who can replace it with hypoallergenic tapes and electrodes. 
&nbsp;

Avoid

<ul>
	<li>Electric blankets</li>
	<li>High-voltage area</li>
	<li>Magnets</li>
	<li>Metal detectors<a href="#accordion">[7]</a>. 
	&nbsp;</li>
</ul>

Conclusion

A Holter monitor is a non-invasive and painless procedure to evaluate cardiac functioning. It is a portable device as small as a cell phone. It monitors and records the heart activity for a longer amount of time as compared to an ECG test.

The technician will advise on how to care for the monitor. The patient has to document any pain, discomfort, or cardiac issues. The cardiac technician should be informed about allergy to any adhesive so that they can make provisions for hypoallergenic tapes and electrodes. 
&nbsp;

Key Takeaways

<ul>
	<li>A Holter monitor previously was as big as a briefcase, consisting of an amplifier, tape recorder, electrodes, a playback unit, and an analysing unit along with 10 electrogram leads. However, advanced technology has introduced a 2-3 leads model.</li>
	<li>Presently, Holter monitor is a portable, battery-operated medical device that aids in measuring cardiac activity, including heart rate and rhythm as well as any chest pain the individual is experiencing. It is often referred to as ambulatory electrocardiography.</li>
	<li>It is a non-invasive procedure that monitors and records the heart activity for prolonged duration as compared to usual ECG test, which can only see the electrical activity of heart for a short period; a Holter test is able to record for continuous long duration activity (12-48 hours).</li>
	<li>A Holter monitor test is useful when a patient presents with palpitation or unexplained fainting. It can show if the prescribed medications are suitable for a patient&#39;s condition. Furthermore, it can monitor abnormal heart rhythm or cardiac arrhythmia after an operation.</li>
	<li>The small pouch bearing the Holter monitor is placed around the neck since it has to be near the chest for accurate readings. Patients are encouraged to carry on with their routine activities; however, they should avoid vigorous exercise and showering/bathing.</li>
	<li>Before the test, the care team is responsible to properly explain it to the patients how to use the Holter monitor to carefully record any pain, discomfort, or any cardiac symptoms they experience during the time period besides taking care of the unit&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;</li>
	<li>During the procedure, electrodes are firmly attached to the skin to get accurate reports. It is not recommended to take shower, swim, or indulge in any water activity; it&rsquo;s also recommended to avoid any sort of high intensity workout.</li>
	<li>There is no risk reported as such; however, some individuals can have an allergic reaction to the transpore or micropore tapes used to attach the electrodes. In that case, it&rsquo;s important to inform the cardiac technologist in advance about any allergy to adhesives so that they can replace it with hypoallergenic tapes and electrodes. 
	&nbsp;</li>
</ul>

[1] Barrett PM, Komatireddy R, Haaser S, et al. Comparison of 24-hour Holter Monitoring with 14-day novel adhesive patch electrocardiographic monitoring. The American Journal of Medicine.

[2] Holter Monitor - StatPearls - NCBI Bookshelf.

[3] Roth E. 24-hour Holter Monitoring: Purpose, procedure, and results. Healthline.

[4] Ambulatory electrocardiogram (ECG) - holter monitoring. National Heart Centre Singapore.

[5] Written By Katy Wallis Updated on October 31. Your guide to holter monitors. Healthgrades.

[6] Holter Monitor. www.heart.org.

[7] Holter Monitor (24h): Medlineplus Medical Encyclopedia. MedlinePlus.

[8] Albers GW, Bernstein RA, Brachmann J, et al. Heart Rhythm Monitoring Strategies for Cryptogenic Stroke: 2015 Diagnostics and Monitoring Stroke Focus Group Report. J Am Heart Assoc. 2016;5(3):e002944. Published 2016 Mar 15. doi:10.1161/JAHA.115.002944

[9] panelJasonMatosRoderickTungPeterZimetbaum Alinks open overlay, JasonMatos, RoderickTung, PeterZimetbaum. Use of the electrocardiogram in acute myocardial infarction. Cardiac Intensive Care (Third Edition).