24-hour ECG Holter Monitoring
24-hour ECG Holter Monitoring is used to assess the risk factor in cases of arrhythmia (palpitations, rapid or slow pulse rate, skipped heartbeats) and for discovering possible cardiac causes of dizziness, fainting and unexplained falls. Monitoring may also be requested in cases of known cardiac diseases (i.e., myocardial disease, inefficient valve function, congenital diseases and coronary heart disease) to ascertain the presence of possible asymptomatic but potentially dangerous heart rhythm disorders (i.e., lack of oxygen to the heart muscles), to check the effectiveness of treatment, as well as check pacemaker function.
Holter Monitoring, Ambulatory Electrocardiography
The examination is used for the continuous monitoring of various electrical activities of the central nervous system for at least 24 hours while the patient is engaged in normal, everyday activities, to show abnormalities that only appear occasionally, such as, rhythm disorders. There are also ECG abnormalities that are not continuous, lasting only a few minutes or seconds at a time not making it possible to be shown on a regular ECG. The monitoring is, primarily, used to show arrhythmia following a heart attack, perhaps to check the effectiveness of the medication treatment.
Electrodes will be attached to your chest. These will be connected to the monitor with lead wires. The monitor box may be worn over the shoulder or it may clip to a belt or pocket. Once you have been hooked up to the monitor, it will begin sending electronic signals from the heart to the monitor and you may return to your usual activities. You will be instructed to keep a diary of your activities during the recording period and, if any symptoms, such as dizziness, palpitations or chest pain or other heart complaints should appear, you will need to push the special button designated for this purpose. The monitor will store this signal as data containing important information for your doctor. The monitor will be removed in 24 hours and the data evaluated.
Before the Procedure
No special preparation is required. Your medications may be taken as usual. Your chest may be shaved, as needed, so that the electrodes will stick closely to the skin.
It is very important that the duration of your activities (i.e., walking, eating, running after a bus, going up stairs, resting, tennis, etc.) and any symptoms or heart complaints be recorded precisely, that neither the monitor nor the electrodes should be removed and that they must be kept away from water. Any washing up should be done prior to electrode placement.
The examination is not dangerous.
The examination is painless.
In normal cases, the heart beats vary accordingly when under physical stress and when at rest, there is no indication of arrhythmia or that the heart lacks oxygen. In pathological cases, arrhythmia and the occasional lack of oxygen should coincide with the periods marked by the patient as having had heart complaints.
Ergometry - Stress ECG
This examination is done on a bicycle ergometer in a sitting position. During the 6-10 minutes of this test the patient is put through an increasingly strenuous cycling routine to test stress-levels whilst the ECG is continually being monitored and the blood pressure controlled.
A stress test is performed to determine causes of chest pain, to see how well people who have had a heart attack or heart surgery are able to tolerate exercise; to help find the cause of symptoms that occur during exercise or activity, such as dizziness, fainting, or rapid, irregular heartbeats; to check for a blockage or narrowing of an artery after a medical procedure, such as angioplasty or coronary artery bypass surgery, especially, if the person has chest pain or other symptoms; to see how well medicine or other treatment for chest pain or an irregular heartbeat is working; and, to measure the load bearing capacity of and screen for possible dangerous factors in persons (i.e., men over 40 and women over 50 years of age with a positive family medical history or other risk factors in younger persons) following a regular training program.
The test is conducted and constantly monitored by a cardiologist. The test may only be taken by persons whose condition is stable, whose blood flow rate is compensated and whose blood pressure is close to normal.
Electrodes will be placed on your chest, arms, and legs to record the heart's activity and a blood pressure measuring cuff placed around your upper arm. You will be asked to pedal on an exercise machine while the electrocardiogram measures the electrical activity of your heart and blood pressure readings are taken. The level of difficulty will gradually be increased. The test continues until you reach a target heart rate, unless complications such as chest pain or an exaggerated rise in blood pressure develop. You will continue to be monitored until your heart rate returns to normal.
You should let your doctor know, before the test, the medications you are taking.
The test cannot be conducted in cases of musculoskeletal and joint disorders, high blood pressure and circulatory failure.
When gel is applied to your skin for the electrodes, it might feel unpleasantly cool.
The blood pressure measuring cuff might be unpleasantly tight when it is being inflated.
Immediately tell your doctor if you feel any chest pain or have difficulty in breathing
24-hour Ambulant Blood-Pressure Monitoring (ABPM)
The purpose of the ABPM is to measure your blood pressure for 24 hours while you are engaged in your normal daily activities.
Blood pressure normally varies during the course of a day, but is affected by such external factors as physical activity, stress, eating, etc. This test is to record occasional changes such as sudden or persistent blood pressure increases, or to check on the effectiveness of your blood pressure medication.
A blood measuring cuff will be placed on your upper arm that is connected with lead wires to a portable blood pressure monitor small enough to hang around your neck or to be attached to your belt. The monitor will periodically measure your blood pressure and pulse rate by inflating the cuff arm and then slowly releasing the pressure and store the results.
Because the test is being carried out to find out what your normal daily blood pressure is, it is important to carry on with your normal routine and do all the things you would normally do. You will be asked to keep a diary of your activities indicating the precise times. You will need to keep the monitor on through the night, also.
At the end of the 24 hours, the machine and cuff will be removed and the readings analyzed.
Before the Test
No preparation is required. You may take your regular medications.
If you have not been taking your medications according to the instructions given, do not do so now. You will not only deceive your doctor, but also yourself, since the monitor will not be measuring the values of the actual medications taken. This is also true if, on the day of measuring, you do something other than your usual activities.
Reminder: Do not remove the monitor or the blood pressure measuring cuff and keep them away from water. Any washing up should be done prior to electrode placement.
The test is not dangerous.
The test is not painful. You may feel some discomfort and wake up during the night when the cuff is being inflated.
The Arteriograph will provide fast information regarding:
- Endothel dysfunction: showing the level of stress the veins are under, that is, how much they are contracted (under stress) or distended (normal).
- Pulse wave velocity of the aorta: information regarding the aorta's stiffness, that is, changes due to atherosclerosis. The higher the velocity, the stiffer the veins.
The procedure is painless and not dangerous, lasts but a few minutes only as long as it takes to measure blood pressure and pulse rate readings while you are lying comfortably on your back.
The TensioClinic Arteriograph is a new Hungarian invention. The invention was awarded the Millennium Prize by the Hungarian Patent Office in 2005.