Holter monitoring - MEDICAL TOURISM CARDIAC PROCEDURE

Holter monitor is a portable heart monitor that records your heartbeats over an extended period of time (usually 24 hours). It is often used to identify problems undetected by a single electrocardiogram.

Holter Monitor- is a process using a tape recorder to record a patient's EKG (Electrocardiogram, EKG or ECG) for 24 continuous hours. As it can be worn during the patient's regular daily activities, it helps the physician to correlate symptoms of dizziness, palpitations - irregular heart rhythm or black outs. As the recording is for a span of 24 hours continuously, this procedure is much more likely to detect an abnormal heart rhythm compared to the EKG lasting less than a minute. It could also help evaluate the patient's EKG while episodes of chest pain, when there may be revealing changes to suggest Ischemia or reduction in blood supply to the muscle of the left ventricle.

Causes

Your physician may request a Holter monitor recording be to evaluate the following conditions:

• Chest pain not reproduced with exercise testing
• Signs and symptoms which may be heart-related, such as fatigue, shortness of breath, dizziness or fainting
• Irregular heartbeats or palpitations
• Risk for future heart-related events in certain conditions, such as idiopathic hypertrophic cardiomyopathy (enlarged heart due to unknown reasons), post-heart attack with dysfunction of the left side of the heart, or Wolff-Parkinson-White syndrome (a condition in which an additional electrical pathway carries an impulse from the atria to the ventricles, causing rhythm problems)
• Function of an implanted pacemaker
• Effectiveness of therapy for complex arrhythmias

There may also be other reasons for your physician to recommend the use of a Holter monitor.

Procedure

A portable ECG monitor is connected to patches on your chest. The monitor is about the size of a small cassette player and is carried in a fanny pack during the recording period. The monitor records your heart's electrical impulses as you go about your daily activities. It can also help evaluate the patient's EKG during episodes of chest pain, during which time there may be telltale changes to suggest ischemia or reduced blood supply to the muscle of the left ventricle.

The monitor hook-up can be done at the hospital as an outpatient. It takes approximately 20-30 minutes to set up the monitor and then you may go home. At the time you are hooked up to the Holter monitor, you will be given a diary to keep during the 24 hours of you study. This diary is a very important part of interpreting your results. You will be given a list of symptoms or activities that occur for you while wearing your Holter monitor.

First the chest is cleansed using an alcohol solution to ensure good attachment of the sticky EKG electrodes. Men with hairy chest need to shave small areas accordingly. Then EKG electrodes (circular white patches on the left) are applied to the chest. Now, thin wires are used to connect the electrodes to a small tape recorder. The tape recorder can be slung over the shoulder and neck with the use of a disposable pouch or is secured to the patient's belt. This recorder is to be worn for 24 hours and the patient is advised to continue their regular or daily activities. In order to avoid getting the setup wet or damaging the recorder, the patient should not shower till the duration of the test. A log or a diary is provided so that the patients could record the activity and symptoms like skipped heartbeats, chest discomfort, dizziness, etc., together with time. The device has an internal clock which records the time on the EKG strips. The recordings can be used to correlate the heart rhythm with symptoms or complaints. The Holter monitor needs to be returned to the laboratory after 24 hours, it can be done by the staff. But, if you need to take a shower before leaving the house or living out of town, the device can be disconnected from the electrodes and sent back to the laboratory, along with the completed diary

After you return the Holter Monitor to the satellite clinic or to the doctor's office, or hospital lab, a technician would scan the recorder after it is removed. Multiple EKG strips are recorded on paper together with a computer-generated data summary which provides complete details about the patient's heart rate and rhythm during the recording. This data or information is then handed over to your doctor.

Risks

The Holter monitor is a noninvasive method of assessing the heart's function. Risks are rare and may include tissue breakdown or skin irritation at the application site, due to the prolonged application of the adhesive electrode patches.

There may be other risks depending upon your specific medical condition. Your doctor would discuss the possible risks before the procedure is done.

Factors or Conditions that can alter the Holter monitor reading are:

• Close proximity to magnets, metal detectors, high-voltage electrical wires, and electrical appliances such as shavers, toothbrushes, and hair dryers
• Smoking, certain medications
• Excessive perspiration, which may cause the leads to loosen or detach

Preparation for the test:

The requirement is that the patient wears loose-fitting clothes. Need to buttons down the front portion of the shirt or tops are advisable. This helps to apply the EKG electrodes, and comfortably carry the monitor in a relatively discreet manner as well.

Preparation for the test:

Approximate time taken is 10 to 15 minutes to apply the monitor and just 5 minutes to remove it. Directions would be given to the patients. Multiple monitors are also equipped with an "event" button. Operating the button during a symptom for e.g., dizziness, will help the technician print an ECG from that time accurately

This procedure is highly safe and not very different from carrying around a small tape recorder for about 24 hours. There would be no serious allergic reactions recorded so far in spite of some patients being sensitive to the electrode adhesive.

Results:

The analysis report is provided to the physician along with multiple EKG strips once the tape has been scanned by the technician. The physician is informed immediately If the technician observes a rhythm that is life-threatening or potentially dangerous; it may take a few days before you get the official results from your physician's office otherwise. You may also receive additional recommendations based upon the results of the test at that time, e.g., a pacemaker may be suggested if a patient has blackouts and the Holter monitor shows a drastic slow heart beat during the tests.