The Ambulatory ECG

So you have to have or are training to put on holter monitors! What are they?

I will start with the ECG holter monitor. In a similar way to the 12 lead ECG, it records the electrical activity in the heart, predominantly looking at the rate and rhythm. However we tend to only use 3 leads (Other countries will use up to 5 leads for this test)

Each hospital has different protocols for set up and administering the test. You may find they will do an initial 12 lead ECG as a baseline, they may use 2 electrodes from an ECG machine and move them around to check for good ECG positions. All should do basic skin preparation, I’m sorry gentleman if you are hairy you will get a shave!

For the purpose of this I will show a specific manufacturer – Spacelabs. There are other manufacturers, but this is the one I know the best.

As I said before we use a 3 lead system, in general these are placed: yellow mid sternum  and the red and green placed on the left and right hand side of the chest. This is not a hard and fast rule, if the physiologist or cardiographer feel they can get a better trace elsewhere this is also fine. The below image is an example of one of these monitors set up, and a little eye candy for you all….

3-channel cardiac Holter monitor
Hopefully you will be given a diary card/symptom sheet. Part of this test is to try and correlate your symptoms to the ECG, so this is quite important! However please help us out by only writing relevant symptoms, we do not need to know what you ate or when you went to the toilet. Please state the date and time of the symptoms, be specific! we can not correlate a time of 12-3pm to one strip of an ECG!

Things that are useful to us when analysing the tape:

-Bed times
-Exercise times
-Symptoms – Palpitations, dizziness, blackout, syncope, chest pain etc

These monitors can be left on from 24hours to 7days. Dependant on the length you may be asked not to shower or bathe as the stickers will come off, however for the longer recording it’s likely you will be given spare stickers and hook up instructions. If this is the case, keep and eye on your skin and re place the electrodes slightly up/down/left or right of the original to minimise irritation.

And YES it must stay on at all times including while you are asleep! I’ve seen far too many that have been taken off early or through the night – these test are incomplete and may require you to wear it again.

If you have any questions about this test or others, do not hesitate to contact me!


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