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Holter Monitoring

The purpose of holter monitoring is the record the heart activity continuously, as the patient follows his normal routine, usually for 24 hours. Other purposes were as follows:
  1. Patient-activated monitor: worn for 5-7 days , to allow patient to manually initiate recording of heart activity when he experiences symptoms
  2. To detect cardiac arrythmias
  3. To evaluate chest pain
  4. To evaluate the effectiveness of antiarrhythmic drug therapy.
  5. To monitor pacemaker function
  6. To correlate symptoms and palpitations with actual cardiac events and patient activities.
  7. To detect sporadic arrhythmias missed by an exercise or resting electrocardiogram (ECG)
  8. Also known as ambulatory ECG or dynamic monitoring.
Patient Preparation
  • Make sure the patient has signed an appropriate consent form
  • Note and report allergies.
  • Provide bathing instructions because some equipment must not get wet.
  • Instruct the patient to avoid magnets, metal detectors, high-voltage areas and electric blankets.
  • Explain the importance of keeping a log of daily activities as well as emotional upsets, physical symptoms, and ingestion of medication.
  • Explain how to mark the tape at the onset of symptoms, if applicable.
  • Explain how to check the recorded to make sure that it's working properly.
Procedure
  1. Electrodes are applied to the chest wall and securely attached to the lead wires and monitor.
  2. Placing electrodes over large muscles masses, such as the pectorals, is avoided to limit artifact.
  3. A new or fully charged battery is inserted in the recorder.
  4. A tape is inserted and the recorder is turned on.
  5. The electrode attachment circuit is tested by connecting  the recorder to a standard ECG machine, noting artifact during normal patient movement.
Postoperative Care
  1. Remove all chest electrodes
  2. Clean the electrode sites
  3. Check for skin sensitivity to the electrodes.
Normal Results
  1. No significant arrythmias or ST-segment changes on ECG.
  2. Changes in heart rate during various activities
Abnormal Results
  1. Abnormalities in cardiac rate or rhythm suggesting serious symptomatic or asymptomatic arrythmias.
  2. ST-T wave changes coinciding with patient symptoms or increased patient activity and suggesting myocardial ischemia.
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