Cardiac Rhythm Monitoring

There are a wide variety of devices available for outpatient cardiac rhythm monitoring. The primary purpose of these devices is the evaluation of suspected arrhythmias that have not been detected by office or hospital based monitoring. These devices differ in the types of monitoring leads used, the duration and continuity of monitoring, the ability to detect arrhythmias without patient intervention and the mechanism of delivery of the information from patient to clinician.

Here is a brief explanation of three monitoring devices commonly used in our office.

What is a Holter Monitor?

A Holter monitor is a continuous tape recording of a patient’s EKG for 24 or 48 hours. Since it can be worn during the patient’s regular daily activities, it helps the physician correlate symptoms of dizziness, palpitaions (a sensation of fast or irregular heart rhythm) or black outs. Since the recording covers 24 hours on a continuous basis, Holter monitoring is much more likely to detect an abnormal heart rhythm when compared to the EKG which prints your heart rhythm during a very small period of time – usually only a few seconds. It can also help evaluate the patient’s EKG during episodes of chest pain, palpitations, dizziness etc. These findings help the physician make proper decisions in your treatment.

What can I expect?

Your chest will be cleansed with an alcohol solution to ensure good attachment of the sticky EKG electrodes. Men with a hairy chest may require a small area to be shaved. The EKG electrodes are applied to the chest. Thin wires are then used to connect the electrodes to a small monitoring device. The monitoring device can be worn on the belt or put in a pocket. The recorder is worn for 24 to 48 hours and the patient is encouraged to continue his/her daily activities.

To avoid getting the equipment wet and damaging the recorder, the patient will be asked not to shower for the duration of the testing. A diary or event log is provided so that the patient can record activity (walking the dog, upset at neighbor, etc.) and symptoms (skipped heartbeats, chest discomforts, dizziness, etc.) together with the time. The Holter monitor has an internal clock which stamps the time on the EKG strips. These can be used to correlate the heart rhythm with the diary of symptoms or complaints.

After the required time, the Holter monitor can be removed and returned to the office with the completed diary.

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Cardiac Event Monitor

Cardiac event monitoring is used to record a patient’s heart rhythm when he/she is experiencing symptoms. It is activated by pressing a button when the patient is experiencing symptoms such as dizziness, palpitations, shortness of breath, fainting spell or chest pain. Since an irregular heart beat might not last long enough to show up on an EKG, a cardiac event monitor can help pinpoint the cause when the heart beat irregularity occurs.

What can I expect?

Like Holter monitoring, an event monitor involves wearing a small, portable EKG recorder over a period of time that can vary from weeks to months. Electrodes are placed on certain areas of the chest and thin wires are attached to the electrodes that are connected to a monitoring device worn on a lanyard around the neck. The patient will also carry a cellular device that can be put on a belt or in a pocket or purse.

The difference between a Holter monitor and event recorder is that the Holter monitor will record an EKG constantly whereas an event monitor only recored an EKG when the patient pushes a button. It is constantly monitoring the heart, therefore having the ability to record an the EKG when the patient senses symptoms and pushes a button. The patient will note their activity and symptoms on the cellular device. The recorded data is sent by the cellular device to your doctor for analysis.

During the time the monitor is worn, patients are encourage to go about their usual activities. The cardiologist will review the recordings and inform the patient about the results at the next visit or sooner, if needed.

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Mobile Cardiac Outpatient Telemetry

This cardiac monitoring device provides real-time monitoring and analysis. In this system, the patient wears a 3-lead sensor, which constantly communicates with the telemetry monitor – a lightweight unit that can be carried in a pocket or purse. It is worn over a period of a couple weeks to a month. Similar to the other monitoring devices, the patient will press a button on the sensor when he/she is experiencing a symptom. The patient also enters a note on the cellular device.

This particular monitor is useful if a patient is asympotmatic (unaware that their heart may be out of rhythm). When an arrhythmia is detected according to preset paramaters, the EKG is automatically transmitted to a central service center. A report of daily heart rates and rhythms are sent to the referring physician. He can request the level and timing of response, ranging from daily reports to STAT results.

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