A Holter monitor is a portable device for continuously monitoring the electrical activity of the heart for 24 hours or more. Its extended recording period is sometime useful for observing occasional cardiac arrhythmias that would be difficult to identify in a shorter period of time. For patients having more transient symptoms, a cardiac event monitor which can be worn for a month or more can be used.

Much like standard electrocardiography (ECG), the Holter monitor records electrical signals from the heart via a series of electrodes attached to the chest. These electrodes are connected to a small piece of equipment that is attached to the patient's belt, and is responsible for keeping a log of the heart's electrical activity throughout the recording period.

Breakthroughs in technology have reduced the size and weight of the recorders (making them easier for the patients to wear), reduced artifact in recording, increased memory capacity, drastically improved the diagnostic capabilities and automated much of the procedure. As a result, the procedure is being done not only by cardiologists, but by many primary care physicians as well.

What is Holter Monitoring and why is it performed?:

Holter monitoring, which is also referred to as ambulatory ECG, monitors a patient’s heart during normal activity for 24 to 72 hours. The monitor, a small device that’s worn by the patient, records every heartbeat during that time, increasing the chances that irregular heartbeats, or arrhythmia, can be detected. The monitor is attached to the patient with a multi-lead ECG cable. If the patient experiences any abnormal symptoms, such as chest pain or dizziness, an event button can be pushed that marks the event, so the technician or physician can view the heart’s activity at that point in time. When the patient returns the monitor, it is disconnected and a report is generated via a computer or printer.

The report can help a physician detect poor blood flow to the heart muscle, indicating possible heart disease or a heart attack, can evaluate treatments (such as medication or a pacemaker) for irregular heartbeats, and assess cardiac function when the patient takes medication that might adversely affect the heart. Abnormal-ities are identified and trending graphs that show patterns of heart rate, ST segment level, and the frequency and patterns of arrhythmia, are produced. Based upon the results of the report, the physician will decide to seek more information or identify a path of treatment.

Indications for Holter Monitoring:

• Syncope (fainting spells)
  
• Weakness
  
• Chest pain
• Abnormal ECG
  
• Post MI
  
• Nausea accompanied by weakness
  
• Dizziness

What type of Physicians perform Holters?

• Family and general practitioners
  
• Cardiologists
  
• DOs
  
• Internal medicine physicians