What information does 24-hour heart monitoring provide? Holter cardiac monitoring - what is it? Device for checking the heart.

An electrocardiogram cannot always detect cardiac pathologies. After all, the study is carried out for a short time and in a state of rest of the patient. 24-hour cardiac monitoring allows the patient to wear a device to record the activity of the main organ. The patient must know the rules for conducting this type of examination and fully comply with them.

Description of the method

Scientist Norman Holter was the first to develop and apply this technique, hence the name - Holter monitoring (or 24-hour heart monitoring). The patient must carry a small mobile recording device (recorder) with him at all times. Special bipolar leads are attached to the chest at the base and apex of the heart.

The entire diagnostic procedure consists of continuously recording heart rhythms, as when taking a cardiogram. The main difference is the duration of daily monitoring. During an ECG, 10-15 seconds are enough to record cardiac capabilities, but this data is often not enough to make an accurate diagnosis. Some pathologies appear periodically, during physical activity or, conversely, only at night.

Indications for testing

In cardiology, the method has been used for more than half a century and allows obtaining reliable data when a simple electrocardiogram does not detect disturbances in the functioning of the heart. There are quite a lot of cases when it is necessary to seek help from this particular diagnostic option. Daily heart monitoring not only reveals various abnormalities, but also allows you to evaluate the performance of the pacemaker.

Indications for using a Holter study include:

• Recent myocardial infarction.
• Heart rhythm disturbances (arrhythmia, tachycardia, angina).
• The patient complains of periodic pain and tingling in the heart area.
• Chronic heart failure.
• Silent ischemia.
• Dizziness of unknown etiology.
• Sudden shortness of breath.
• Chronic circulatory failure.
• Evaluation of the effect of certain medications on cardiac activity.
• Control study after completing a course of therapy.
• Examination before and after surgery.
• Changes in blood pressure.
• Feeling of suffocation and chest pain.

Diagnostics are mandatory for persons whose activities involve a high degree of responsibility (pilots, divers, crane operators, industrial climbers).

Types of examination

Depending on the indications, the doctor must select a specific type of study using the Holter method. Currently, full-scale diagnostics are more often used, in which a device for daily heart monitoring operates on a continuous basis for 24 or 48 hours. If necessary, the period can be extended to three days. In the first day alone, the device records up to 120,000 heartbeats. An electrocardiogram allows you to record no more than 50 beats in a short period of time.

The fragmentary type of survey involves continuous or periodic (event) recording. In the first option, recording the state of the heart begins from the moment the patient feels the symptoms of the pathology. To do this, he just needs to press a button on the device. The method is suitable even for cases where the patient has fainted. With daily heart monitoring in a fragmentary manner, the device will record the state of the heart some time before the patient can press the button after regaining consciousness.

The second type of fragmentary examination is necessary for patients in whom signs of cardiac disorders are observed quite rarely. A miniature device for recording information can be worn on the wrist. It is more convenient to use than one that still needs to be attached to the chest when symptoms are detected.

What does 24-hour heart monitoring show?

The Holter device detects any dysfunction of the heart in a variety of situations, not just at rest. This helps to detect the factor causing deviations.

Cardiac arrhythmia, which is characterized by a sudden appearance and disappearance, can be recorded exclusively by 24-hour cardiac monitoring. How is the examination carried out in this case? The most reliable result will be shown by a full-scale study. Thanks to this method, premature contractions of various parts of the heart, paroxysmal tachycardia (a sharp increase in the number of heart beats), and atrioventricular block (failure in the transmission of electrical impulses) are detected.

Carrying out the procedure

In order to obtain valuable and reliable information, it is necessary to correctly attach the electrodes to the chest. The wires coming from them are connected to a small recording device. The recorder itself is small in size and can be attached to a belt. Daily cardiac monitoring should be carried out even during sleep, so the patient must ensure that the device is connected.

Throughout the diagnosis, the patient leads a normal lifestyle, goes to work, and rests. You will also need to keep a diary where the following events that affect the functioning of the heart are recorded:

1. Morning awakening time.
2. Eating foods that can change your heart rate (coffee, strong tea, chocolate).
3. Any physical activity (jogging, climbing stairs).
4. Emotional stress.
5. Taking medications.
6. Bedtime time.

Sometimes doctors specifically prescribe certain actions for the patient, which he must perform and record the time in a diary.

Holter monitoring in pediatrics

Sometimes situations arise when daily heart monitoring for a child is prescribed by doctors (pediatrician, cardiologist) or sports coaches. The reason for this may be the need for a simple examination, for example, for more serious and heavy loads during training, or suspicion of a heart disease. For children, the device does not cause any discomfort and is attached in the same way as in the case of diagnosing the heart function of an adult.

The recorder can be worn around your neck or hidden in your pocket. All wires will be hidden under clothing. The child should adhere to the usual daily routine, attend classes at school or kindergarten, and walk outside. The device will record the work of the heart under different loads. The method allows you to determine possible deviations in the form of arrhythmia, bradycardia, tachycardia.

Patient preparation

No special preparatory actions are required to prepare for Holter monitoring. An exception is the preliminary manipulations that a man must perform. In order for the device to record true readings, it is necessary to shave the hair from the chest in the place where the electrodes will be attached. This will ensure proper adhesion to the skin.

Patients are interested in what 24-hour heart monitoring looks like and whether any discomfort is felt. There is no need to worry about this, since the electrodes are fixed on an area of ​​skin that has been previously lubricated with a special gel. The method does not cause any painful or unpleasant sensations.

General recommendations include taking a shower, because on the days of diagnosis, hygiene procedures will be limited. The functionality of the recorder may be somewhat affected by radio devices or a working microwave oven. The patient also needs to sleep on his back (or side) so as not to disturb the placement of the electrodes.

24-hour heart monitoring: what should not be done during the study?

The use of the recording device requires careful handling. Some manipulations can damage it or distort the results of diagnosing cardiac activity. To avoid negative consequences, you must first of all prevent the device from coming into contact with liquid. The mechanism will not withstand the shower test, so during the examination you will have to forget about water procedures for the upper body.

Patients are strictly prohibited from increasing physical activity without a doctor’s prescription! This can lead to serious consequences in the form of a heart attack, surges in blood pressure, and stroke.

The Holter device should be protected from direct sunlight and electromagnetic waves. This can significantly affect the final result of cardiac monitoring. You should choose the right clothing while wearing the device. It is advisable not to wear tight clothes and avoid synthetic material that does not allow air to pass through well. The electrodes will quickly move away from a wet surface.

The name of the Holter monitoring system comes from the name of the creator of the device that allows you to study cardiac activity. The first device was bulky and weighed about 40 kg. Patients were forced to keep him close to them until the procedure was completed.

A modern device for daily monitoring is more compact; it is placed directly on the patient’s body and weighs about 500 grams.

The essence of the study

The procedure is an instrumental technique. It is designed to identify pathologies in the functioning of the heart muscle.

During the examination, the functioning of the cardiovascular system is monitored:

• The data is taken using electrodes attached to the skin in the sternum area, then transferred to a recorder - a special device that reads the information and stores it until decrypted;
• Deviation of parameters from the norm serves as a basis for identifying serious diseases;
• Modern devices are equipped with electronic memory, while older models use magnetic tape for recording;
• For fragmented monitoring (carried out only during attacks of pain or discomfort), there are miniature devices that fit in the palm of your hand.

The patient's activity can remain at the same level, he continues his daily activities (rest, exercise, lunch, work, communication).

The order of the study, how it is carried out

What is it used for?

A referral for daily ECG monitoring is given by a cardiologist or therapist after a preliminary examination, during which a diagnosis is formulated and details are clarified (for example, a list of medications taken).

Daily ECG monitoring is used to detect:

• type of heart rate and heart rate periodicity;
• pathologies (pauses, paroxysmal disorders);
• heart rate variability;
• oxygen deficiency (ischemia), in which patients usually complain of a “lump in the throat,” heartburn, burning or pressing pain behind the sternum, soreness in the elbows and lower jaw;
• malfunction of the pacemaker;
• dynamics of health status, assessment of treatment effectiveness.

What does monitoring show?

1. How rhythmically the heart muscle contracts.
2. If a rhythm disturbance is detected, does it pose a danger? Is there a possibility of death, is surgery necessary?
3. The nature of the pain bothering the patient. Is their source from the heart, is it affected by physical activity and stress.
4. The cause of fainting and pre-fainting conditions.
5. Allows you to evaluate how effective the prescribed antiarrhythmic therapy is and monitor the work of the pacemaker.
6. Changes in the rhythm and work of the heart during sleep.
7. Threat of myocardial infarction. If not enough nutrients are reaching the heart muscle, the Holter will show this.

Indications for use

Typically, the reason for installing a device that allows recording the dynamics of blood pressure and electrocardiogram is the patient’s complaints:

• cough, shortness of breath, feeling of lack of air, not associated with diseases of the bronchopulmonary system;
• sudden dizziness, fainting;
• attacks of cardialgia (pressing and burning pain behind the sternum in the area of ​​the heart muscle);
• excessively rapid heartbeat at rest or under special circumstances (stress, exercise, eating);
• "heart sinking"

In the above cases, the role of 24-hour Holter monitoring plays the following role:

• determines under the influence of which factors the failure occurred, whether there is a dependence on the time of day and other circumstances;
• investigates the cause of poor health: coronary artery disease or interruptions in rhythm and conduction;
• establishes the factor of cardiac dysfunction.

Also, the need to conduct heart monitoring using the Holter method may arise when:

Contraindications

This type of study of cardiac activity has no contraindications. If necessary, it can also be used for pregnant women. Monitoring for children is carried out according to the same scheme as for adults.

But in some patients, conducting the study may be technically impossible due to:

1. severe degree of obesity;
2. severe chest injuries;
3. the presence of wounds or burns in the area where the electrodes are attached.

Preparation for the procedure

1. If prescribed by a specialist, a standard cardiogram can be drawn up before the study.
2. Men are advised to shave their chest hair. This is necessary so that the electrodes are securely attached to the skin, and the information received is reliable.
3. Before the procedure, you should thoroughly cleanse the skin and take a shower.
4. The body must be dry; after water procedures, gels, creams and other moisturizers should not be applied.
5. If the patient is taking any medications, it is important to notify the specialist about this. He may cancel your appointment during the study period.
6. Sometimes the doctor asks you to bring batteries for the device. When purchasing them, pay attention to the labeling. Choose alkaline batteries; their standard size can be AA or AAA; check this by studying the instructions supplied with the device.
7. If a patient is allergic to contact with an adhesive plaster, he should buy a product marked “hypoallergenic” at the pharmacy. A silk-based patch will also work.
8. Before the study, you need to get a good night's sleep and have breakfast.
9. To place the monitor comfortably, it is best to wear a T-shirt and a loose-fitting sweater or shirt over it.

Decoding the results

The main amount of work when conducting research is deciphering the data obtained. A day later, the device is disconnected from the patient, connected to a PC and the information is assessed. The device stores a significant amount of information and the doctor must take into account a number of parameters when drawing up a conclusion.

There is no single form for writing a daily monitoring report, but it must necessarily include the following points:

• heart rate, source;
• deviations of the ischemic index;
• duration of pauses in heart contractions (for adults the norm is up to 1750 ms, for infants - from 1000 ms);
• ST index;
• description of the dynamics of the QT, PQ intervals. For adults, the normal duration of the QT interval is 500 ms, for infants from 400 ms;
• stability/changes in the morphology of the QRS complex;
• if a pacemaker is present, the functioning of the device is analyzed;
• The observation diary is studied and data on changes in the ventricular complex are presented.

None of the devices designed for daily monitoring can accurately describe the work of the heart.

The data stored in the device must be deciphered by a cardiologist. The specialist adjusts the values ​​based on the patient’s records. If deviations from the norm are detected, the doctor attaches an ECG to the transcript, which reflects the signs of pathology.

The importance of conducting a Holter ECG is undeniable. It helps the cardiologist to timely identify and begin treatment of such serious diseases as hypertension, ischemia and others.

© Use of site materials only in agreement with the administration.

Continuous long-term (up to 7 days) recording of an electrocardiogram using the Holter method or Holter monitoring (HM) is quite widely used for various heart diseases. However, this method has gained the greatest popularity for diagnostics, painless forms, etc.

Holter makes it possible to detect connections with attacks and heart rhythm disturbances, to find the causes of pressure surges and many pathological conditions of the cardiovascular system.

Where to make a halter and how much should you pay for it?

Citizens of the Russian Federation who have a health insurance policy can get a holter for free under certain conditions:

• By referral from a physician or cardiologist, if they suspect the development of cardiac pathology, for the diagnosis of which it is necessary to undergo Holter monitoring;
• Staying for treatment in a municipal hospital if there is a need for additional examination;
• Unfavorable course of pregnancy (as directed by antenatal clinics);
• Conscription into the ranks of the Armed Forces of the Russian Federation (here you won’t need an insurance policy).

Unfortunately, a free examination often involves some difficulties. For example, a patient may be asked to buy and bring batteries or electrodes because the municipal clinic has run out of them, or to wait a couple of months because registration for the near future has long been completed. In such situations, only conscripts who do not seek to replenish our valiant army behave calmly (whoever needs it, let him worry). Other categories of citizens (potential patients of cardiologists, pregnant women and young men dreaming of a military career), worried about their health and trying to get results faster, try not to put off the examination. They simply go to look for paid medical centers that have the necessary equipment - as a rule, there are no huge queues (usually they have to wait no more than a week).

The price of a paid holter varies depending on the status of the clinic, region, characteristics of the equipment and the time of its use:

• You can undergo daily monitoring using a 3-channel recorder for 2-3 thousand (on average);
• Installing a holter that records with a 12-channel recorder will cost approximately double the price of a 3-channel one - 4-5 thousand rubles.

Anyone can get a holter for a fee, regardless of the reason, place of residence, citizenship - the price does not change.

Deceive Halter? This is a utopia...

Is it possible to deceive the Holter so that it hides a disease that has been bothering the patient for a long time, or, on the contrary, registers deviations when in fact nothing bad is happening in his body?

It is difficult to deceive a holter if a person has not passed the medical examination, but really wants to pass it. More often, young people who have their sights set on professional military service in elite branches of the military or who want to serve in the Ministry of Internal Affairs, that is, who intend to devote their lives to work that requires endurance and good health, are prone to such deception.

Often, pilots who are not allowed to fly for health reasons, as well as drivers, crane operators, builders and representatives of other professions with special working conditions, try to distort the information in a Holter monitoring device. Not reaching retirement or simply wanting to prolong their work in a certain field, and not being able to undergo a mandatory medical examination, they are looking for loopholes to deceive medicine by changing the results for the better during the prescribed examination.

We hasten to disappoint you, no forum will most likely advise such people. If they somehow help lower blood pressure, then certainly nothing can be done about rhythm disturbances and other problems in the heart.

Antiarrhythmic drugs used on one's own initiative may have the opposite effect and will only make the situation worse, so it’s better not to do it. Medicines prescribed by a doctor for rhythm disturbances will also not particularly affect the results - Holter will detect problems in the cardiovascular system. The doctor involved in decoding will probably sympathize with the person, but will not resort to official forgery and, most likely, will recommend that you accept the blow of fate with dignity and try to look for another job.

Often, so-called “draft evaders” try to distort the results of daily monitoring, for whom service is only an obstacle to achieving other goals. What don’t they advise each other on different forums? Those who received the “white” ticket claim that they succeeded with the help of:

• Squats with breath holding;
• Coffee in large quantities several times a day;
• Tablets to increase blood pressure;
• Per minute smoking;
• Sex all day long;
• Significant physical activity without sleep breaks;
• Excessive alcohol consumption;
• Several harmful factors used simultaneously (coffee, pills, smoking or another set).

Probably, you can raise your blood pressure in this way and last a day, but you shouldn’t underestimate doctors. Suspecting deception, they will put the “deserter” in a hospital, where cases of pressure rise during the day will be less frequent (you can quietly run up the stairs during the day), and will disappear altogether at night - the medical staff will ensure that the subject does not violate the regime.

Video: about Holter monitoring of ECG and blood pressure - a specialist’s opinion

Video: mini-report on Holter monitoring

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

The basis of the work of the heart muscle is the conduction of electrical impulses through it, causing contraction of muscle cells. This phenomenon was studied and formed the basis for recording various heart diseases using a device called an electrocardiograph - a device for recording an electrocardiogram (ECG). If there are pathological processes in the heart, changes in the ECG are detected that are characteristic of certain diseases (coronary artery disease, arterial hypertension, and others).

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 an ECG against the background of physical activity. To diagnose such forms of diseases, ECG with physical activity (treadmill test, bicycle ergometry), as well as daily Holter ECG monitoring are used.

Daily ECG monitoring is an instrumental method for diagnosing diseases of the cardiovascular system, based on recording during the day electrical activity that occurs during the activity of the heart muscle (myocardium) and changes 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 a doctor, has electrodes installed on his chest 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 memory. If the patient is simultaneously wearing a cuff on his shoulder (an analogue of a conventional device for measuring blood pressure - a tonometer), then in this case monitoring allows the dynamics of blood pressure measurements to be carried out over the course of a day using an oscillometric (electronic) method.

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

Device for Holter ECG monitoring

Holter monitoring of ECG and blood pressure has a number of advantages over standard ECG and ECG with physical activity, since with a single ECG performed at rest and lasting several minutes, it is not always possible to register myocardial ischemia or paroxysmal (paroxysmal) rhythm disturbances. The method also makes it possible to record an ECG in a state of normal everyday activity, with physical activity familiar to patients, which is important for correcting the treatment of patients whose heart function deteriorates with minimal activity. In addition, we can note the availability of the method, ease of research, non-invasiveness (no damage to body tissues).

Indications for Holter monitoring

This research method is used in the following cases:

1. Diagnosis of IHD (coronary heart disease)
- Prinzmetal's angina (vasospastic),
- painless (“silent”) myocardial ischemia,
- stable and unstable angina,
— previous myocardial infarction, especially its painless form
- condition after suffering sudden cardiac death
2.

diagnosis of arterial hypertension
3. Diagnosis of heart rhythm disorders
- sick sinus syndrome,
- Wolff-Parkinson-White syndrome (WWW syndrome),
- long QT syndrome,
- atrial fibrillation,
- AV block, sinoatrial block,
- ventricular tachycardia
4. Heart defects
— for the diagnosis of rhythm disturbances, often accompanying acquired heart defects, especially mitral valve defects
5. Routine examination
— persons subject to surgery 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 (for angina pectoris),
- cardiac surgery for coronary artery disease (stenting of coronary arteries, aorto-coronary bypass surgery) and for arrhythmias (radiofrequency, laser ablation - destruction of additional pathways in the heart, installation of an artificial pacemaker and monitoring its effective operation),
— prescription and evaluation of the effectiveness of antihypertensive (BP-lowering) drugs.

Holter monitoring may be prescribed if the patient experiences the following symptoms:

- pressing or burning pain 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

At the moment there are no contraindications for the study. But in some patients, the study may not be technically feasible, for example, with severe chest injuries, extensive wounds or burns on the skin of the chest, or with a very severe degree of obesity.

Preparing the patient for Holter blood pressure and ECG monitoring

The patient does not need to prepare specially for this study. The day before, 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 contractility and conduction functions of the heart muscle.

How is the research conducted?

The patient can be referred for the procedure either from the clinic or from the hospital department in which he is undergoing inpatient treatment at the time of the examination (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 into the office, where the doctor gives instructions about the upcoming study. Next, electrodes (5 – 7 depending on the device model) are installed on the patient’s skin on the anterior chest wall using disposable stickers resembling an ordinary adhesive plaster. These electrodes are connected to a portable device that is worn on the chest or belt. In the case of a bifunctional (double) study, when ECG monitoring is carried out together with blood pressure, the patient is placed on the upper arm, also connected to the device. The entire installation procedure takes no more than 10 minutes, without causing any discomfort.

Next, the patient is given a diary, where on a form in the form of a tablet it is necessary to note the time and actions performed at this time, as well as pain or other discomfort. That is, the patient must record everything that happens to him during the 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 from the point of view of the effect of a particular drug on the functions of the heart. During the study, you should 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 that has already been analyzed by the device itself. The doctor evaluates the data received and issues a conclusion, which should be transferred to the attending physician in the near future for subsequent correction of treatment if necessary.

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

Decoding the results of daily monitoring

What will the patient read in the received research protocol? In addition to the given 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
- 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-.

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, disturbances in 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 related to the load, whether they were accompanied by pain, shortness of breath or other subjective signs.

Are there possible complications during monitoring?

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

General practitioner Sazykina O.Yu.

www.medicalj.ru

What does Holter monitoring show?

In the diagnosis of cardiovascular diseases, ECG is of great importance. The only drawback of this method, which complicated the diagnosis of pathologies, was considered to be the impossibility of monitoring the work of the heart for a long time. The American Norman Holter managed to eliminate it 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 visible inconvenience. 24-hour Holter ECG monitoring is a continuous monitoring of the work of the patient’s heart muscle in a familiar environment. With its help, the doctor records the symptoms of the emerging pathology and establishes its cause. This type of diagnosis is carried out in different ways:

1. A detailed recording of the patient's heart rate over several days, which records about 100 thousand heartbeats.
2. Using a subcutaneous implant, a multi-month large-scale recording is performed.
3. Episodic assessment of heart function during physical stress on the body or pain in the chest. In this case, the device operates by pressing a button by the patient himself.

Holter monitoring - explanation

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. The cardiologist enters all the data recorded by the device into the computer, makes corrections and issues a conclusion. After deciphering and carefully analyzing the monitoring results, the patient receives a detailed conclusion and a referral for treatment, if such a need arises.

The monitoring results are described 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 arrhythmia, if any, and other disturbances in the functioning 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 final portion 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. Based on the diagnostic results, the condition of the heart muscle, the sufficiency of its blood supply or the presence of oxygen starvation is determined. The norm is the sinus rhythm of the myocardium and heart rate within 85 beats per minute. Daily monitoring of heart rate is used if coronary heart disease is suspected.

Signs of this disease appear when the conductivity of the coronary arteries decreases. In this case, the Holter registers ST segment depression. The ischemia index with Holter monitoring is a decrease in ST to 0.1 mV. An examination of a healthy heart will show a different picture: in the absence of coronary artery disease, the norm is considered to be an elevation of this area of ​​up to 1 mm.

Holter monitoring system

Many cardiovascular diseases do not cause specific symptoms in the initial stage. The patient may feel discomfort in the chest area only during active life or at night. An abnormal heart rhythm (arrhythmia), which is characterized by instability, is very difficult to detect during a routine electrocardiogram in a clinical setting.

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

Application of electrodes during Holter monitoring

A mobile electrocardiogram is performed by a recorder that records heart rate readings using disposable electrodes. The Holter monitoring device itself runs on batteries 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, accept from 2 to 12 independent ECG channels and are equipped with a cable with 5, 7 or 10 branches to which electrodes are attached. They are fixed on the patient's chest using a patch in places with the least amount of fatty tissue.

During the examination, it is assumed that a special gel is used, 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 double research. In addition to monitoring myocardial function, the doctor has the opportunity to track the dynamics of the patient’s blood pressure. Daily Holter monitoring of ECG and blood pressure is prescribed to confirm or refute a preliminary diagnosis, for example, in case of coronary artery disease.

Holter ECG monitoring is a continuous graphical recording of myocardial contractions, which is one of the two main diagnostic techniques for various diseases of the cardiovascular system. It is considered the most effective in detecting arrhythmia and latent forms 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 a device and measures blood pressure in parallel with the electrocardiogram. Sometimes an abnormal heart rhythm directly depends on “jumps” in blood pressure at certain times of the day or as a result of physical or emotional stress. Holter blood pressure monitoring helps establish this connection, find and eliminate the cause of the pathology.

Holter monitoring – how to behave?

Patients who have been prescribed 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:

1. Before starting the procedure, it is important to take a bath or shower, as the device should not be exposed to water.
2. There should be no metal products on clothing or on the body.
3. It is important to tell your doctor about any medications you are taking if they cannot be stopped.
4. It is necessary to provide the specialist with the results of tests and other diagnostic methods.
5. It is necessary to inform medical personnel about the presence of a pacemaker, if any.
6. You should 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 bring any benefit. Try to spend this time as on normal days, doing your usual things.

Holter monitoring – what not to do?

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

1. Do not use electrical appliances (toothbrush, razor, hair dryer, etc.).
2. Keep a sufficient distance from microwave ovens, metal detectors and magnets.
3. X-rays, ultrasound, CT or MRI should not be performed during monitoring.
4. At night, sleep on your back so that the device is not subject to mechanical stress.
5. Do not wear synthetic underwear or outerwear.

Holter Monitoring Diary

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 food products and drinks;
• housework;
• physical exercise;
• emotional condition;
• duration and quality of sleep;
• taking medications with an exact time indication; this aspect is very important if Holter blood pressure monitoring is carried out in parallel;
• the presence of unpleasant or painful sensations in the heart area, dizziness, lightheadedness, headache, etc.

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

womanadvice.ru

Holter ECG monitoring and its varieties

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

Holter ECG monitoring is also prescribed for:

• the patient is diagnosed with arterial hypertension for the first time;
• diagnosis of white coat hypertension;
• heart defects;
• moderate or severe hypertension that cannot be treated;
• previous myocardial infarction;
• there is acute heart failure or a chronic form of the disease;
• it is necessary to monitor the operation of the pacemaker;
• there is a disease of the endocrine system or the patient is obese.

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

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

Tell your doctor what medications you have taken in the recent past, as many of them may affect your heart function.

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

At the moment, the Holter examination is considered the best and most informative, and therefore ECG monitoring is used even in cases where a person simply needs to conduct a general diagnosis of the body and his health. Daily monitoring of the heart rhythm using a recorder helps make an accurate diagnosis.

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

A fragmentary study is prescribed when the patient begins to experience 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 performed in continuous mode.

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

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

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

24-hour heart monitoring (Holter ECG): proper preparation and implementation

Daily cardiac monitoring begins with preparing the patient for the procedure. Be sure to take a shower so that during the diagnostic process the person does not experience any unpleasant sensations. Wear cotton clothing that does not interfere with air-water exchange.

Also, during daily heart monitoring, the patient should avoid contact with equipment that can form a magnetic field around itself that negatively 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. Electrodes are always attached to the least mobile skin, which prevents the risk of equipment malfunction.

24-hour full-scale heart monitoring takes heart readings when the patient leads a normal and habitual lifestyle, applies various physical activities, does physical exercise, runs and performs other activities.

Everything that the patient does during daily (1 or more days) heart monitoring is also recorded in a diary, which indicates the type of action, the time of its implementation, and his feelings. These are night sleep, meals, types of physical activity, medications, rest, stress, characteristics of the condition (deterioration or improvement, no change).

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

• protecting equipment from moisture so that the accuracy of data is not compromised due to equipment breakdowns;
• do not expose the equipment to temperature changes, this is necessary for objective data from studies carried out in conditions familiar to the patient;
• Holter heart monitoring will be accurate if during the diagnostic process you do not experience vibrations or pressure changes (airplane flights, attractions);
• maintaining a normal lifestyle without the risk of stress;
• during Holter diagnostics, when heart monitoring is performed, higher physical activity than usual cannot be used. First of all, because the data will be inaccurate, and also because the electrodes may move away from the skin.

Patients should rest on their back to avoid disturbing the position of the electrodes. As a last resort - 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 condition of the heart, any changes in its functioning under different conditions and actions. Thanks to this technique, which was developed long ago by an American scientist, it is possible to obtain data that a regular cardiogram or examination by a doctor would never provide.

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

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

As we have already noted, there are no negative effects on the patient’s body or health during the study. The heart recorder does not cause any disturbances in the functioning of the heart. This daily (with different durations) ECG monitoring is prescribed to people at any age, with different suspicions of a diagnosis of heart disease.

Indications for the use of heart rate monitoring during the day are patient complaints of fainting and pre-fainting conditions, frequent attacks of arrhythmia. The doctor prescribes diagnostics even in cases where there is a suspicion of the presence of a pathology leading to death.

The risk group includes patients with high blood pressure, diagnosed with left ventricular dysfunction, valvular heart defects, and disorders. This also includes patients who are suspected of asymptomatic cardiac ischemia, variant angina, or silent ischemia.

Daily Holter ECG monitoring: interpretation of results and complications

Daily 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 completing 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, daily Holter ECG monitoring allows making accurate diagnoses, timely noticing pathological changes in the condition of the heart, disturbances in its functioning, and prescribing effective and adequate therapy that prevents the development of severe forms of diseases and complications.

The standard set of received data must include:

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

Daily full-scale Holter ECG monitoring provides results that can help solve a lot of problems that can arise when the heart is in a negative state and its functionality is impaired.

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

Also, the study helps to identify all the difficulties that arise from cardiac arrhythmia against the background of heart disease: 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 data analysis shows the ineffectiveness of treatment, a different method of therapy is selected.

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

Today, daily or fragmented 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, and ventricular ectopia are also determined.

With an increased likelihood of arrhythmia 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 the response rate is greater than 180 beats per minute.

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

• paroxysms of ventricular tachycardia, in which the increase in rhythm occurs gradually and turns into ventricular flutter;
• early ventricular extrasystole leading to vulnerable period tachycardia;
• 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 while taking various antiarrhythmic drugs. The analysis is carried out based on data such as a 4-fold or 10-fold increase in the number of extrasystoles per day, as well as the manifestation of tachycardia, which was not previously observed in the patient.

Myocardial ischemia during examination is detected by ST segment elevation or depression.

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

The main tasks of diagnosis remain the identification and assessment of cardiac rhythm disturbances, as well as the search for those areas in which displacements and fluctuations of the ST segment will be clearly expressed. As additions, an analysis of the duration of intervals in the heart rhythm, the work of the ventricles, and their activity is also assessed.

A modern cardiac recorder helps to obtain a complete and accurate picture of how the heart operates and prevent the occurrence and development of serious conditions.

Today, Holter diagnostics are carried out in specialized cardiac centers and hospitals. The procedure is available and costs from 1,500 rubles. The functionality of the research methodology helps you quickly complete this procedure without investing additional financial resources, changing your lifestyle, or other inconveniences.

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

med88.ru

Indications for use

For what symptoms is it prescribed?

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

This procedure is especially popular when the patient is bothered by unpleasant symptoms, and a conventional electrocardiogram and ultrasound of the heart did not show any abnormalities.

For accurate diagnosis of arrhythmia

This examination is prescribed for patients with suspected atrial fibrillation (paroxysmal) tachyarrhythmias. They are almost impossible to diagnose using a regular ECG, since they manifest themselves in the form of attacks, and the patient cannot come for diagnosis right during one of them. Paroxysmal tachyarrhythmias can appear with the following diseases:

• congenital heart defects (WPW syndrome, LGL syndrome, cardiomyopathy);
• previous myocardial infarction or multiple microinfarctions;
• angina pectoris;
• myocardial ischemia.

It is also possible to diagnose other types of arrhythmias, for example, extrasystole.

To monitor the effectiveness of treatment

Daily monitoring of cardiac 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 installing a pacemaker to check whether it is working correctly.

Preparing 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 your 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 activities	Watching TV, reading, crafts, studying, writing
Activities that may require emotional stress	Playing computer or gambling games, driving vehicles
Light physical activity	Walk in the park, morning exercises
Average physical activity	Climbing stairs above the 3rd floor, easy jogging
Intensive loads	Workout in the gym, jogging for more than 20 minutes. Attention! Be sure to check with your doctor whether you can perform this type of action during daily ECG monitoring. In addition, make sure that during exercises the electrodes do not come off and the data recording device is not damaged.

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

If during the study you felt any unpleasant symptoms (dizziness, palpitations, etc.), be sure to list them in your 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, you need to adhere to certain rules:

• Wear tight-fitting clothes made from natural fabrics. It is better not to wear loose clothing, as it may cause the electrodes to peel off from the body. And synthetic fabric can become electrified, which will distort the device’s readings. There should be no metal elements on clothing above the waist.
• Do not overcool or overheat the device.
• Do not expose it to water or other liquid.
• Do not place it on vibrating surfaces.
• Do not stay near electrical equipment or transformer boxes.
• Do not use a laptop or mobile phone for more than 3 hours a day. Do not bring the gadget closer than 30 cm to the Holter ECG monitoring device. Do not go close to a running microwave oven.
• Do not sit or lie on the device. Place it so as not to press it while you sleep.
• Make sure that the electrodes do not come off.
• Do not undergo physical therapy or have x-rays taken during the examination.
• Ask your doctor in advance if you can exercise during the test.

Decrypted data

On the results sheet you will see the following indicators.

Index	Norm
Average heart rate during the day	60–100 beats per minute
Average heart rate at night and during daytime sleep	41–81 beats/min
Daily graph of heart rate changes	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 The permissible quantity that does not threaten life and health is 200 pcs. per day
The duration of the QT and PQ intervals and the schedule of their changes.	Normal QT interval: 340–450 ms (0.34–0.45 s) for women and 340–430 ms for men PQ – 120–200 ms

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

Click on photo to enlarge

Contraindications and side effects

Holter monitoring is an absolutely painless procedure.

It has no contraindications. Can be used during pregnancy and breastfeeding, as well as in the elderly and children.

Does not cause side effects.

Holter monitoring or Holter study is a procedure for monitoring the heart throughout the day. Holter monitoring is a common method for diagnosing heart disease. This diagnostic method allows you to identify disturbances in the functioning of the cardiovascular system.

Holter monitoring is a study in which data is continuously recorded throughout the day. At the same time, a person can move and lead a normal lifestyle. Cardiac monitoring is carried out using a portable device. During the examination, the patient wears it on a belt or fastened to a belt over the shoulder.

Such diagnostics allows you to evaluate the work of the myocardium, determine pressure drops and identify possible pathologies. Holter monitoring can be recorded for 7 days.

The information is read and sent to the recorder. In this special device it is processed and stored in memory. The device weighs about 500 g and can keep a complete record or record individual fragments.

Continuous research gives more accurate results, and recording is made within 1-3 days.

Fragmentary monitoring involves recording individual fragments, which the patient initiates independently during periods of rhythm disturbance, discomfort, etc.

Holter monitoring allows you to evaluate the work of the heart during wakefulness and sleep, the cyclic changes that occur, their duration, nature and intensity. The study also helps to determine the form of angina, as well as to trace the connection between a person’s sensations and the readings of the device.

Indications for Holter examination

A doctor can prescribe cardiac monitoring if the patient has complaints of rapid heartbeat, loss of consciousness, dizziness, etc.

Holter monitoring is performed in the following cases:

1. Periodic increase in pressure.
2. Ischemic disease.
3. Angina pectoris.
4. Cardiomyopathy with hypertrophy.
5. Previous heart attack.
6. If comprehensive measures have been taken to eliminate it, a Holter examination is also carried out to assess their effectiveness.
7. Such diagnostics are carried out to determine the cause of arterial hypertension, to monitor the functioning of the pacemaker, and in the presence of a prolonged QT interval.

Patients with congenital heart disease should undergo periodic examination. In addition, a Holter examination is indicated for people who are overweight and have disorders in the endocrine system.

Preparation and procedure

There is no need to prepare for Holter monitoring. If the examination is prescribed for a man, and he has hair in the chest area, then the hair needs to be removed. The electrodes may not adhere well, and as a result, the information will be unreliable. It is advisable to take a hygienic shower. The skin should be clean and dry, no need to lubricate with cream.

If the patient has been taking medications, the doctor may temporarily stop taking them.A special device is used that will record data over several days. In the future, the received data will be transferred to the computer’s hard drive. Recording can be carried out in three channels, thanks to which you can obtain reliable information.

Electrodes are glued to the patient's skin using a patch, and the device is secured to the belt with a belt.

During this period, the patient leads a normal lifestyle and does not limit himself in anything. If necessary, the cardiologist may ask you to keep a special diary where daily activity will be recorded.

It should note all actions and sensations throughout the day: dizziness, rapid heartbeat, stress when climbing stairs. The time must be indicated.

Cardiac monitoring has some limitations during the study:

• Showering and bathing are prohibited.
• You cannot visit the bathhouse.
• Various impacts should be avoided.
• Avoid contact with aggressive chemicals.
• The device must not be wet or exposed to different temperatures.

Extensive physical activity is not recommended, as sweating may cause the electrodes to come off. It is recommended to wear cotton clothing, as synthetic fabric can cause the accumulation of static electricity.

What can the procedure “tell” about?

At the end of the day, the device is removed and connected to the computer. Since the device records a lot of data, the conclusion is drawn up by the doctor taking into account all the parameters. The doctor determines the background rhythm and heart rate, conduction disturbances, and pauses during the period of heart activity.

If previously data decoding was carried out manually, now all signals can be processed automatically.

A 24-hour heart test is a valuable diagnostic method, through which you can obtain the following information:

• Seizures.
• Conduction of the heart.
• Episodes of ischemia.

The procedure also allows you to evaluate the work of the heart under normal conditions, after physical activity and as a result of the influence of emotional stimuli.

More information about Holter monitoring can be found in the video:

Holter cardiac monitoring can detect abnormalities such as:

• Tachycardia
• Bradycardia
• Atrial fibrillation
• Ventricular ectopy
• Bigeminy
• Arrhythmia

If the results reveal ST segment elevation, it indicates cardiac ischemia.The results obtained can only be analyzed by a doctor who has a complete clinical picture of the patient.

A Holter electrocardiogram can be prescribed at any age, and there are no contraindications to this. In addition, the study can be carried out during pregnancy.The study is not carried out in case of inflammatory processes on the patient’s skin. This is the only limitation for daily monitoring.

Holter and ECG of the heart: which is better and what is the difference

To identify the work of the heart during wakefulness and sleep within 24 hours, 24-hour Holter monitoring or Holter monitoring is indicated.

The electrocardiogram is recorded continuously for a day or several days.

A distinctive feature of a regular cardiogram from a Holter ECG is the recording in a certain period of time at the time of the examination. Attacks of arrhythmia will not be detected on an ECG an hour later and will not detect low-grade valve defects, which in most cases are not accompanied by electrical impulses.

In addition, a standard ECG records cardiac activity for 45-50 beats, and continuous Holter recording - about 100 thousand beats.

Holter monitoring, unlike a conventional ECG, is more informative, where many parameters can be analyzed. In addition, the latest models of the device have an additional function for monitoring blood pressure.