Holter monitoring is a registration of the heart and blood pressure for a long time (from 12 hours to 7 days). The term was named after its inventor - biophysicist Norman Holter. This type of diagnosis gives a complete picture of the patient’s cardiovascular system in the usual conditions. The method is used in a complex of diagnostic measures to identify pathology, monitors the course of therapy and monitors the functionality of the installed pacemaker.
The essence of the method
This diagnostic method makes it possible to track the condition of the heart over a specific period of time. Holter monitoring is carried out using a compact Holter instrument. All data is recorded in the memory card. In fact, the small device is a mini-computer. The electrocardiogram gives a momentary picture of the state of the heart, and monitoring shows changes in the work of the heart and blood pressure over a given time at standard loads for the patient.
The doctor, guided by the condition of the patient, determines during what period Holter monitoring will occur. The duration of the process takes at least 12 hours, other periods of time must be a multiple of 12 (24, 48, 72 or more hours).
Types of monitoring
When performing Holter ECG monitoring (in contrast to the standard cardiogram), it is always more reliable and informative to monitor all changes. The electrocardiogram recorded in the clinic will record about 50 heart rhythms, and Holter's - more than 100 thousand. Modern equipment is able to read data for 1 year (the implant is placed under the skin).
At the moment, the equipment not only reads heart data, but also carries out Holter blood pressure monitoring. Committing changes is divided into categories:
- Permanent - information is collected continuously throughout the study period.
- Fragmentary - a combined method. Over a certain period of time, the device performs standard monitoring, and after launch it is carried out only in certain situations.
Fragmented monitoring is used to diagnose cases of arrhythmia, a malfunction in the heart rhythm, provided that this is a rare occurrence, so it is difficult to fix it with a standard procedure. This type of ECG fixation can be prescribed for a period longer than one day. The patient himself presses the device start button in case of a crisis event. Information about the work of the myocardium in intermediate states is also stored in the memory of the device. For fragmented registration, more compact devices are used. Some of them fit in your pocket, others are put on your hand, like a regular watch.
When research is needed
Heart monitoring and Holter blood pressure are necessary in cases where alarm signals indicate a disease, but pathology does not yet have clinical symptoms and it is not possible to identify the cause with a standard approach. In addition to these cases, long-term fixation of indications is necessary for many patients with cardiovascular pathologies.
The main advantages of the method:
- Fixation of myocardial indices over a long period of time.
- Evaluation of the work of the heart muscle with various types of load and at rest.
- Continuous cardiography tracks the slightest deviations, the manifestation of which cannot be fixed by standard methods.
What demonstrates
Holter monitoring makes it possible to evaluate the myocardial functionality in the usual conditions for the patient, taking into account the variables of the emotional state, physical activity and resting state during sleep. In addition, the information collected allows you to:
- Determine myocardial rhythm disturbances, register their number, cyclicity, duration, intensity and nature (ventricular, supraventricular). Monitoring also shows the total number of untimely heart contractions and provides accurate statistics, revealing indicators outside the normal range.
- Detects angina pectoris and its form, as well as asymptomatic coronary heart disease.
- Identifies the causes of pain in the myocardium (osteochondrosis, neuralgia).
- Defines the prerequisites for the development of ischemia (load threshold, pulse, conditions for the occurrence of violations).
- It makes it possible to superimpose the readings of the device on the subjective sensations of the patient, described in the diary, and to trace what the connection consists of. Interpret patient symptoms and ECG data as part of the diagnostic process.
- Holter ECG monitoring clarifies the diagnosis, which makes it possible to prescribe adequate treatment, change the treatment strategy, and monitor the effectiveness of the prescribed procedures.
- The method is indispensable for evaluating the operation of a pacemaker.
Indications for the study
Holter monitoring is recommended in cases of symptoms of unexplained etiology, anxiety, insomnia, worsening in unexpressed pathology. Holter ECG is usually prescribed for one day. In most cases, this period is enough to identify the problem. If within 24 hours there has been no deterioration, the device has not recorded deviations, and the patient has complaints, then monitoring is extended until the result is received.
Daily Holter monitoring is indicated in such cases:
- Fainting, pre-syncope, dizziness, swelling, periodic bouts of weakness.
- Rare manifestations of arrhythmia, not amenable to fixation in other ways.
- High blood pressure, anxiety over a long period.
- Insomnia, unstable sleep, nightmares.
- Hypotension accompanied by weakness, fainting, headache, etc.
- To determine the risk of developing ischemia or to identify pathology.
- Diagnostic examination after an attack of myocardial infarction, monitoring the dynamics of therapeutic measures.
- Monitoring the condition of a patient with hypertension, atrial fibrillation.
- Monitoring the condition of patients with chronic diseases (congenital heart disease).
- Examination with preventive purposes for patients at risk.
- Inspection of persons of military age.
Device
Holter monitoring is an instrumental method of research. Modern recorders have 3 or 12 channels, memory capacity up to 200 MB. The device consists of a recorder (captures a cardiac signal) and a built-in decoder. Data from the memory is extracted by a doctor who decrypts the results. The total weight of the device is not more than 500 grams, but there are also compact models that are more suitable for fragmented monitoring.
The Holter monitoring device is attached to the belt or hung on the neck. Special disposable sensors are tightly attached to the patient's chest. The duration and mode of fixation is determined by the doctor, he also gives the patient a special diary for the study period. Records are kept every hour. It is necessary to note the regimen of the day, taking medications, sensations, complaints and well-being.
Preparation
Halter diagnostics do not require any preparation and creation of special conditions for the procedure. There is one point that men with copious hairiness need to complete. To ensure a snug fit between the electrode sensors, hair must be shaved.
The specialist gives in each case individual recommendations. For example, increased physical activity (walking up the stairs) or the exclusion of vigorous activity. A general recommendation is to maintain a normal lifestyle. After a day, the patient returns to the clinic to take information and the device itself or to take data with subsequent monitoring for an extended period.
Rules for the patient
There are certain conditions under which the patient will successfully undergo Holter monitoring. What can not be done when performing this type of research:
- Subject equipment to overcooling or overheating.
- Allow moisture on the device.
- Avoid vibrating surfaces, the close proximity of electrical networks, microwave ovens, transformer booths.
- It is necessary to limit work at a computer, laptop to 3 hours a day. During use, the equipment must be at least 30 cm from the halter.
- Do not lie down or sit on the appliance.
- If physiotherapy or x-ray examination is prescribed, then these procedures must be postponed to the period after the completion of Holter monitoring.
- You can’t swim, take a shower.
- It is forbidden to engage in physical exercises or hard work (with the exception of cases when there are instructions from a specialist to perform these actions).
The patient needs to monitor the position of the electrodes and make sure that they do not detach from the skin throughout the entire observation period. During the monitoring period, it is necessary to wear clothing made from natural fabrics that fit tightly to the body. Synthetic fabric can give an additional static charge, and free-cut clothing can help unstick electrodes.
The appointment for the procedure is done by a cardiologist, and he will subsequently make a transcript of Holter monitoring. You can conduct a study at any time, preparation for this type of diagnostic measures is not required. Starting studies, it is necessary to obtain the doctor’s instructions regarding medications, clarify their cancellation or obtain permission for standard medication.
Decryption
The data analysis of the registrar is carried out using a special computer program. Modern devices are equipped with the necessary software for the initial stage of ECG decryption, which greatly facilitates the tasks of the doctor.
The interpretation of Holter monitoring is carried out in parallel with the loading of the data from the observation diary, which was conducted by the patient. The program analyzes the data, correlates them in time, errors are eliminated manually by a specialist. Based on the entire array of information, a conclusion is written about the diurnal state of the myocardium and changes in blood pressure.
The conclusion shall indicate:
- Type of conduct (continuous, combined, fragmentary), type of observation (ECG, blood pressure, combined).
- Heart rate (total, total, maximum and minimum values).
- Type of myocardial contractions in the average and extreme values, indicating the time of deviations (tachysystole, normosystole, bradysystole).
- Parameters of reactive heart rate (with increasing load) - the norm, achievement or non-achievement of submaximal values.
- Heart rate during rest (sleep).
- The level of exercise tolerance.
- The data on heart rate disturbances (the number of episodes, consideration of extrasystole values) are analyzed.
- Data on intraventricular conduction disorders or stating the norm.
- The level of blood supply and its indicators. In the context of analysis, ECG data are correlated with diary entries, given the presence or absence of physical activity. When fixing complaints of shortness of breath and pain in the sternum, coronary heart disease is suspected.
- In the presence of a pacemaker, data on its functioning are recorded.
All abnormalities in the work of the heart and blood vessels are recorded by Holter monitoring ECG. The decryption made by the specialist includes a printed cardiogram, its description, and the doctor’s comments. The whole process does not take more than 1 hour, but the issuance of results and an advisory appointment are usually scheduled the next day.
Combination of observations
The Holter monitoring system may include a bifunctional version of the study. It involves fixing the ECG and blood pressure (BP) for a day or more. This combination allows the doctor to track pressure fluctuations, and not focus on a single measurement.
Measurements of blood pressure provide complete information about the distortion of the daily pressure level, make it possible to exclude or confirm hypertension, assess the presence of short-term rises in blood pressure during the day or night, and identify hypotonic indicators. In addition, monitoring of blood pressure (with an established diagnosis and ongoing therapy) helps to determine the effectiveness of treatment, to make adjustments to it.
Where to go for research
Citizens of the Russian Federation have the opportunity to undergo Holter monitoring for free (if there is an MHI policy) in such cases:
- As prescribed by the attending physician (therapist, cardiologist), if there is a suspicion of the development of any heart pathology.
- When examining in a hospital, if specialists considered it necessary to obtain additional data about the patient’s health status.
- In the direction of the antenatal clinic with suspected adverse pregnancy.
- In the direction of the medical commission of the military registration and enlistment office, to assess the health of the conscript
Free diagnostics are often fraught with a number of difficulties - a long queue, broken equipment, etc. Patients who are in dire need of research go to private medical institutions where a similar service is also performed, and the queue lasts no more than a week. Monitoring costs from 2 to 5 thousand rubles, which depends on the region, the status of the clinic and the type of recorder used.
Daily diagnosis by Holter allows you to record an ECG without losing time, but with the maximum result, to identify the dynamics of blood pressure. Decryption of data using software reveals the functioning of the autonomic nervous system, its effect on the functioning of the myocardium and cardiac arrhythmias. This study can provide an exhaustive picture of the pathology or become a platform for further research on the patient’s health, but in a clearly chosen direction.