24-Hour Holter Monitor

What is a Holter Monitor?
A holter monitor is a kind of electrogardiogram (EKG or ECG) that is used to monitor heart beats continuously for 24 hours or longer. A “resting”, or standard ECG is very simple and one of the fastest ways to evaluate a person’s heart. Small electrodes are placed at certain places on the limbs and chest. When lead wires to an ECG machine connect to these electrodes, the machine measures and interprets the electrical activity of the heart. This information is printed out for the physician to analyze and to further investigate.

What is the Heart’s Electrical Conduction System?
The heart is basically a pump created by muscle tissue. The pumping action is done by an electrical conduction system that organizes the contraction of different heart chambers. The sinus node (also called SA node or sinoatrial node) is a tiny mass of tissue in the right atrium of the heart that generates the primary electrical stimulus.

Normally, the SA node creates a regular electrical stimulus 60 to 100 times per minute. The impulse goes down through conduction pathways (similar to how electricity goes through power lines) and tells the heart to pump out blood and contract. The left and right upper chambers of the heart are stimulated first so they contract shortly before the left and right lower heart chambers.

This electrical impulse then goes from the SA node to the AV (atrioventicular) node. Within the AV node, the impulse is momentarily slowed down before continuing through the conduction pathway to the two ventricles. The impulse divides into left and right pathways to give electrical stimulation to the left and right ventricles.

All of this is monitored and measured by an electrocardiogram. A tracing (graphic representation) of the electrical activity can be generated by putting electrodes at certain parts of the body, like the arms, chest and legs. If there are any changes in an ECG from a normal tracing, it might suggest one or more heart-related conditions.

Why Would a Doctor Request a Holter Monitor?
Dr. Khorrami may request a holter monitor if you have symptoms such as fainting, low blood pressure, dizziness, and palpitations that continue to happen without a clear diagnosis from a resting ECG.

Some other reasons your doctor might request a holter monitor include:
  • Assessing future risks for heart-related problems in certain conditions, such as heart attacks. cardiomyopathy (abnormalty thicked heart), or Wolff-Parkinson-White syndrome (a condition with an abnormal electrical conduction pathway in the heart).
  • Identifying nature of palpitations or irregular heartbeats
  • Evaluating other heart related signs, such as shortness of breath, fatigue, or fainting
  • Assessing an implanted pacemaker’s function
  • Evaluating chest pain that is not reproduced with exercise testing
  • Determining effectiveness of complex arrhythmias therapy
Some dysrhythmias may only occur sometimes, or under certain conditions such as stress. Therefore, Dr. Khorrami might ask for a holter monitor to better capture any abnormal rhythms that might be causing your symptoms. The holter monitor will record continuously for 24 hours and sometimes up to 48 hours. Most holter monitors have an event monitor button that the patient pushes when symptoms occur.

Are There Any Risks using a Holter Moniter?
A holter monitor is a safe and non-invasive method to assess heart function. A problem may only arise if you leave the electrode patches on too long. Prolonged contact with the adhesive patches might cause skin irritation or tissue breakdown where it was applied.

How is a Holter Monitor is placed?
  • You will be required to take off any jewelry or other objects that can interfere with the reading.
  • You will need to take off your clothing from the waist up so the technician can attach electrodes to your chest. She will cover you with a gown or sheet and only expose the necessary areas to apply the electrodes.
  • The holter monitor will be connected with lead wires to the electrodes. The monitor might clip onto a belt or pocket, or be worn over the shoulder.
  • Chest wall hair may need to be shaved or clipped so the electrodes can stick closely to the skin. The skin will also be cleaned where the electrodes will be placed.
  • Once everything is hooked up you will be given home instructions. After that, you can go back to your usual schedule, such as chores, work, and exercise, unless Dr. Khorrami tells you otherwise.
  • You will be asked to keep a diary during the recording period of your holter test. You will need to write the date and time, especially if any symptoms occur, such as dizziness, chest, pain, or palpitations.
What If I Have An Abnormal Result?
Getting an abnormal result might mean you have some type of arrhythmia. It might also mean that your heart isn’t getting enough oxygen. The holter monitor may also detect conduction block, which is a condition where the atrial electrical activity is delayed or does not continue from the atria to the ventricles.

Discuss Your Options with Dr. Khorrami
Dr. Khorrami has been in practice since 1996 as a double-board certified Internist, has experienced a variety of patient cases, and is well trained to solve your cardiac problems. Get in touch to learn more about getting a 24 hour holter and how you can benefit from it.


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About Dr. Khorrami

Dr. Payman Khorrami is a UCLA graduate, has been in practice since 1996, and is double board certified. Undergraduate Education at University of California, Berkeley, Medical School at University of California, San Francisco, Internal Medicine Training at University of California, San Diego Read Full Bio