Holter Monitoring - Diagnostic test for heart diseases

A Holter monitor test is an ambulatory electrocardiographic recording. It allows assessment of your cardiac rhythm on a continuous basis. The recording system uses an audiotape, recorded at an extremely slow speed.

You will be asked to wear a portable recording instrument, the "Holter" monitor. This instrument may be worn by a strap over your shoulder or attached around your waist. It looks like a slightly oversized walk-man in a canvas case. When the nurse or technician opens the Holter monitor, you will see that it takes a standard size audiotape. It is powered by a nine-volt battery.

The monitor has five or seven lead wires that will be attached to electrodes which you will wear on your chest.

You will wear the monitor for 24 hours.

Why does my doctor want me to undergo this test?
The reasons for ordering a Holter monitor test vary. You may have complained of certain symptoms such as chest pain, palpitations, fainting, or irregular heart beats. If you are using a pacemaker, your physician may want to assess its functioning over a 24 hour period of time.

If you are unsure as to your physician's reason for ordering this test, discuss it with him or her..

What are the risks or dangers of this test?
This is a noninvasive procedure. There are no risks or dangers

What preparations should I make before the test?
It's a good idea to shower or bathe before the test, because you will have to refrain from these activities for the 24 hours of the test.

What should I wear to the test?
You will be asked to remove your clothing above the waist, so wear items that are easy to remove.

How long will the test take?
You will have to report to your doctor to be fitted with the monitor. The test is usually. performed for a period of 24 hours, but occasionally, a physician may order it for 48 hours. You will report back to your doctor the following day to return the equipment and the tape recording.

Must I sign a consent form?
You will not have to sign a consent form for this test.

Will I be given local or general anesthesia?
You will not need or be given any anesthesia for this test.

What will happen on the day of the test?
After you have removed the garments above your waist, a nurse or technician will clean the areas of your chest where the electrodes will be placed. If you are a male, the first step will be to shave those areas with a disposable, safety razor. Some men find this to be a unpleasant. The nurse or technician will shave as little hair as possible.

Next, the nurse or technician will clean the areas with alcohol. If you have a scratch, it will sting a little. Then he or she will use gauze to dry the areas.

Then the nurse or technician will place five or seven electrodes on your chest. These will usually be round disks with a gel on one side and a snap on the other. The gel is sticky and will feel cold for a second. The snap is attached to a lead wire, which is attached to the portable monitor. One of the wires is a ground wire.

Sometimes, the nurse or technician will loop the wires near the electrodes and tape the electrodes to your chest. This will prevent the wires from shaking and adversely affect the recording.

The monitor may feel a little heavy, but it is perfectly safe and comfortable.

Who will be in the room with me during the test?
Usually a nurse or technician will perform the test.

Will I have any responsibilities during the test?
The nurse or technician will provide you with a diary or log to complete. You will make an entry every time you have any of the following symptoms: pain, headache, dizziness, shortness of breath. You will also record any strong emotion (crying, anger, laughing, etc.); or other physical symptoms. For each entry you will be asked to record the time it occurred and what your activity was at the time.

You should also record the following activities. eating, sleeping, exercising, moving bowels, engaging in sexual activity, drinking (especially alcohol or caffeinated beverages), and taking medications.

Is there anything I shouldn't do during this test?

During the 24 hours of Holter monitoring, you should not shower, bathe or swim, as any moisture will loosen the electrodes. You may sponge bathe.
Do not use any body power or talcum.
Avoid using electric blankets, as they may interfere with the recording.
Do not remove the monitor. Keep the strap around your waist or shoulder while moving about.
Do not remove any tape that has been placed over the lead wires.
Do not shake the wires.
If a lead wire comes unsnapped from an electrode, just snap it back on and record this in your diary.
Do not open the monitor. This may cause it to fail to record.
Do not drop the monitor.

The nurse or technician may provide you with some tape in case the tape comes off a wire. This could happen in the summer when the moisture from perspiration may loosen the tape.

Otherwise, you may engage in normal activities, including listening to a real walkman or other stereophonic equipment.

What will I feel during this test?
You will not feel anything during the Holter monitoring.

What happens after the test?
After 24 hours, the battery will give out and the tape will be full. Return to your doctor's office where a nurse or technician will remove the electrodes. This part of the test may hurt briefly, particularly if you have hair on your chest and there is tape on the electrodes. It feels like a bandage being pulled off

What should I do after the test is finished?
After the recording is completed and the electrodes have been removed, you may have temporary red marks where the electrodes were placed. Don't scrub them, because the skin may chafe. Gently wash these spots a little bit each day. If you have sensitive skin, it may break out. .You may wish to use a skin care product to soothe any skin irritation.

What happens next?
A technician will analyze the information on the tape recording. A report will be provided to your physician.

What kinds of information will the test give my doctor?
The test will let your doctor know if your have any arrhythmias (irregular heart beats) or myocardial ischemia (decreased oxygen to the heart).

What will my doctor do next?
Your doctor will explain the results of the test to you. If necessary, he or she may order additional tests, prescribe medications or recommend another form of treatment.