Holter monitoring is a recording of the work of the heart and blood pressure for a long time (from 12 hours to 7 days). The term is named after its inventor, biophysicist Norman Holter. This type of diagnostics gives a complete picture of the work of the patient's cardiovascular system in his usual conditions. The method is used in a set of diagnostic measures to detect 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 monitor the state of the heart over a certain period of time. Holter monitoring is carried out using a compact Holter device. All data is recorded in the memory card. In fact, a small device is a mini-computer. An 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 patient loads.
The doctor, guided by the patient's condition, determines during what period the Holter monitoring will take place. The duration of the process takes at least 12 hours, the remaining periods of time must be a multiple of 12 (24, 48, 72 or more hours).
Types of monitoring
When performing Holter ECG monitoring (unlike a standard ECG), it is always more reliable and informative to track all changes. An electrocardiogram taken in the clinic will record about 50 heart rhythms, and a Holter one - 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 performs Holter monitoring of blood pressure in parallel. Committing changes is divided into categories:
- Continuous - information is collected continuously throughout the study period.
- Fragmentary - combined method. For a certain period of time, the device performs standard monitoring, and after that it starts up only in certain situations.
Fragmentary monitoring is used to diagnose cases of arrhythmia, a failure 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 start button of the device in case ofcrisis case. Information about the work of the myocardium in intermediate states is also stored in the memory of the device. For fragmentary 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
Holter monitoring of the heart and blood pressure is necessary in cases where alarm signals indicate a disease, but the pathology does not yet have clinical symptoms and the standard approach fails to identify the cause. In addition to these cases, long-term fixation of indications is necessary for many patients with cardiovascular pathologies.
Main advantages of the method:
- Fixation of myocardial parameters over a long period of time.
- Assessment of the work of the heart muscle under various types of load and at complete rest.
- Continuous cardiography monitors the slightest abnormalities, the manifestation of which cannot be fixed by standard methods.
What shows
Holter monitoring makes it possible to assess the functionality of the myocardium in the patient's usual conditions, taking into account the variables of the emotional state, physical activity and state of rest during sleep. In addition, the information collected allows:
- Determine myocardial rhythm disturbances, register their number, cyclicity, duration, intensity and nature (ventricular, supraventricular). Monitoring also shows the total number of untimely cuts.heart and gives accurate statistics, identifying indicators outside the norm.
- Detects angina pectoris and its form, as well as asymptomatic coronary heart disease.
- Identifies the causes of pain in the myocardium (osteochondrosis, neuralgia).
- Determines the prerequisites for the development of ischemia (load threshold, pulse, conditions for the occurrence of disorders).
- It makes it possible to superimpose the readings of the device on the subjective feelings of the patient described in the diary, and trace the connection. Interpret patient symptoms and ECG data as part of the diagnostic process.
- ECG Holter monitoring clarifies the diagnosis, which makes it possible to prescribe adequate treatment, change the therapy strategy, and monitor the effectiveness of prescribed procedures.
- The method is indispensable for assessing the performance of the pacemaker.
Indications for research
Holter monitoring is recommended in cases of symptoms of unknown etiology, anxiety, insomnia, worsening of the condition with 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 was no deterioration in the condition, the device did not record deviations, and the patient's complaints remained, then the monitoring is extended until the result is obtained.
24-hour Holter monitoring is indicated in the following cases:
- Fainness, pre-syncope, dizziness, swelling, occasional bouts of weakness.
- Raremanifestations of arrhythmia, not amenable to fixation in other ways.
- High blood pressure, long-term anxiety.
- Insomnia, unstable sleep, nightmares.
- Hypotension accompanied by weakness, fainting, headache, etc.
- To determine the risk of ischemia or pathology.
- Diagnostic examination after an attack of myocardial infarction, tracking 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).
- Prophylactic screening for patients at risk.
- Examination of people of military age.
Device
Holter monitoring is an instrumental research method. Modern registrars have 3 or 12 channels, memory capacity up to 200 MB. The device consists of a recorder (fixes the cardio signal) and a built-in decoder. Data from the memory is retrieved by the physician who interprets the results. The total weight of the device is no more than 500 grams, but there are also compact models that are more suitable for fragmentary monitoring.
The Holter monitor is attached to the belt or hung around the neck. Special disposable sensors are tightly attached to the patient's chest. The duration and mode of fixation is determined by the doctor, who also gives the patient a special diary for the period of the study. Records are kept everyhour. It is necessary to note the daily routine, taking medications, sensations, complaints and well-being.
Preparation
Holter diagnostics does not require any preparation and creation of special conditions for the procedure. There is one item that is required for men with abundant hairiness. Hair must be shaved to ensure a snug fit for the electrode sensors.
The specialist gives individual recommendations in each case. For example, increasing physical activity (climbing stairs) or avoiding strenuous activity. The general recommendation is to lead a normal life. After a day, the patient returns to the clinic to take information and the device itself, or to take data, followed by monitoring for an extended period.
Patient guidelines
There are certain conditions under which the patient will successfully undergo Holter monitoring. What not to do when performing this type of research:
- Expose equipment to hypothermia or overheating.
- Allow the appliance to be exposed to moisture.
- Vibrating surfaces, close proximity to electrical networks, microwave ovens, transformer boxes should be avoided.
- It is necessary to limit the work at the computer, laptop to 3 hours a day. During the period of use, the equipment must be at a distance of at least 30 cm from the holter.
- Do not lie down or sit on the device.
- If appointedphysiotherapy or X-ray examination, these procedures should be rescheduled for the period after the completion of the Holter monitoring.
- You can not swim, take a shower.
- It is forbidden to engage in physical exercises or hard work (except 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 peel off the skin throughout the entire observation period. During the monitoring period, it is necessary to wear clothes made of natural fabrics that fit snugly to the body. Synthetic fabrics can provide additional static charge, and loose clothing can cause the electrodes to come off.
The appointment for the procedure is made by a cardiologist, he will subsequently decipher the Holter monitoring. You can conduct a study at any time, preparation for this type of diagnostic measures is not required. Before starting research, you need to get instructions from a doctor about medications, clarify their withdrawal, or obtain approval for standard medication.
Transcript
Data analysis of the recorder is carried out using a special computer program. Modern devices are equipped with the necessary software for the initial stage of ECG decoding, which greatly simplifies the doctor's tasks.
Holter monitoring is deciphered in parallel with diary data uploadobservations made 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 daily state of the myocardium and changes in blood pressure.
The conclusion states:
- Type of conduction (continuous, combined, fragmentary), type of observation (ECG, blood pressure, combined).
- Heart rate (total, total, maximum and minimum values).
- Type of myocardial contractions in average and extreme values, indicating the time of deviations (tachysystole, normosystole, bradysystole).
- Reactive heart rate parameters (with increasing load) - the norm, achievement or failure to reach the submaximal value.
- Resting (sleep) heart rate.
- The level of exercise tolerance.
- Data on heart rate disturbances are analyzed (number of episodes, consideration of extrasystole values).
- Data on disorders of intraventricular conduction or statement of the norm.
- The level of blood supply and its indicators. In the context of analysis, ECG data are correlated with diary entries, taking into account the presence or absence of physical activity. When fixing complaints of shortness of breath and pain in the sternum, coronary heart disease is suspected.
- If a pacemaker is present, data on its functioning are recorded.
All deviations from the norm in the work of the heart and blood vessels are recorded by ECG Holter monitoring. Transcription made by a specialist includes a printedcardiogram, its description, doctor's comments. The whole process does not take more than 1 hour, but the issuance of results and consultation appointments are usually scheduled the next day.
Combination of observations
Holter monitoring system may include a bifunctional version of the study. It involves recording the ECG and blood pressure (BP) for a day or more. This combination allows the doctor to track pressure fluctuations, rather than relying on a single measurement.
Measurements of blood pressure provide complete information about the distortion of the daily level of pressure, allow you 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, blood pressure monitoring (with an established diagnosis and ongoing therapy) helps to determine the effectiveness of treatment and make adjustments to it.
Where to apply for research
Citizens of the Russian Federation have the opportunity to undergo Holter monitoring for free (if they have a compulsory medical insurance policy) in such cases:
- As prescribed by the attending physician (therapist, cardiologist), if there is a suspicion of the development of any pathology of the heart.
- During an examination in a hospital, if the specialists considered it necessary to obtain additional data on the patient's state of he alth.
- Referral from the antenatal clinic in case of suspected unfavorable course of pregnancy.
- In the direction of the medical commission of the military enlistment office, to assess the he alth of the conscript.
Free diagnostics are often associated with a number of difficulties - a long queue, broken equipment, etc. Patients who urgently need an examination turn to private medical institutions, where such a service is also provided, and the queue lasts no more than a week. Monitoring costs from 2 to 5 thousand rubles, depending on the region, the status of the clinic and the type of recorder used.
Daily Holter diagnostics allows you to record an ECG without losing time, but with the maximum result, to identify the dynamics of blood pressure. Data decoding using software reveals the functioning of the autonomic nervous system, its effect on myocardial function and cardiac arrhythmias. This study can give an exhaustive picture of the pathology or become a platform for further research into the patient's he alth, but in a clearly chosen direction.
