Daily( holter) monitoring of ECG and AD - Causes, symptoms and treatment. MF.

Indications
Contraindications
Preparation and monitoring process
Decoding results
Complications of monitoring

At the heart of the cardiac muscle is carrying out electrical impulses on it, causing a contraction of muscle cells. This phenomenon has been studied and is the basis for recording various heart diseases with a device called an electrocardiograph - an apparatus for recording an electrocardiogram( ECG).If there are pathological processes in the heart, changes in the ECG that are characteristic of certain diseases( IHD, arterial hypertension, and others) are revealed.

But not always a complete picture of a particular disease can be obtained with only routine electrocardiography, since there are latent( hidden, "dumb") forms of heart disease that do not manifest themselves clinically and are registered on the ECG against physical stress. To diagnose such forms of diseases, ECG with physical exertion( treadmill test, veloergometry), as well as daily monitoring of the ECG according to Holter.

Daily monitoring of ECG is an instrumental method for diagnosing diseases of the cardiovascular system, based on the registration during the day of electrical activity that occurs during the activity of the heart muscle( myocardium) and varies depending on the presence of certain heart diseases in the patient.

The essence of this method, developed by the American scientist Holter, is as follows: the patient is assigned to the thorax by electrodes reading the information on the heart's operation and connected to a portable device in which the obtained data is processed and recorded in the form of graphic curves - electrocardiogramstored in the device memory. If a cuff on the shoulder is simultaneously applied to the patient( analogous to a conventional blood pressure monitor - a tonometer), then in this case, monitoring allows the dynamics of BP measurements to be performed in a 24 hour oscillometric( electronic) manner.

In diagnostically unclear cases, the study can be extended to seven days if the successful registration of pathological changes on the ECG has not been successful in the first 24 hours, and the patient continues to be troubled by the symptoms about which the examination was prescribed.

Device for Holter monitoring of ECG

Monitoring of ECG and blood pressure by Holter has several advantages over standard ECG and ECG with physical activity, since with a single ECG, held at rest and lasting several minutes, it is not always possible to register myocardial ischaemia or paroxysmalparoxysmal) rhythm disturbances. The method also allows ECG recording in a state of usual household activity, with the usual physical loads for patients, which is important for correcting the treatment of patients who have cardiac deterioration with minimal activity. In addition, it can be noted the availability of the method, the simplicity in the study, not invasiveness( no damage to body tissues).

Indications for Holter monitoring

This test method is used in the following cases:

1. Diagnosis of coronary heart disease
- angina of princemetal( vasospastic),
- painless( "mute") myocardial ischemia,
- stable and unstable angina,
- suffered myocardial infarction, especially its painless form
- condition aftersudden cardiac death
2. Diagnosis of arterial hypertension
3. Diagnosis of cardiac arrhythmias
- syndrome of sinus node weakness,
- Wolff-Parkinson-White syndrome( ERW syndrome),
- syndromem long interval QT,
- atrial fibrillation,
- AB blockade, sinoatrial block,
- ventricular tachycardia
4. Heart defects
- for diagnosis of rhythm disturbances that often accompany acquired heart defects, especially mitral valve defects
5. Routine examination
- persons subject to surgical intervention in the heart and other organs
- patients with diabetes mellitus( diabetic angiopathy - vascular pathology, including coronary arteries)
6. Efficiency monitoring-
- antiarrhythmic and antianginal( for angina pectoris),
- cardiac surgery for coronary artery disease( coronary artery stenting, coronary artery bypass grafting) and for arrhythmias( radiofrequency, laser ablation - destruction of additional pathways in the heart, installation of an artificial pacemaker and monitoring of its effective work),
- the appointment and evaluation of the effectiveness of antihypertensive( lowering blood pressure) drugs.

Holter monitoring can be prescribed if the following symptoms appear in the patient:

- pressing or burning pain behind the sternum and in the heart area, with or without irradiation( giving under the left scapula, in the left arm or not);
- pain in the left half of the chest of a different nature, with a clear connection to or without physical exertion;
- characteristic pains in the region of the heart in the night( usually in the pre-morning) hours - are characteristic for Prinzmetal angina pectoris;
- a sense of lack of air, episodes of severe shortness of breath with suffocating cough;
- periodic interruptions in the work of the heart, a sense of sinking heart;
- frequent dizziness and / or fainting.

Contraindications for daily monitoring

There are currently no contraindications for the study. But in some patients the study may not be technically feasible, for example, with severe chest injuries, extensive wound or burn surfaces on the skin of the chest, with a very pronounced degree of obesity.

Preparing the patient for holter monitoring of blood pressure and ECG

The patient does not need to be specially prepared for this study. On the eve you can eat and drink in the usual amounts, in the morning before the procedure, a light breakfast is allowed. Alcohol and coffee should be excluded, as well as reducing the number of cigarettes smoked, since these products can have a significant effect on the function of contractility and conduction of the heart muscle.

How is the research done?

The patient can be referred to the procedure both from the polyclinic and from the hospital department, where at the time of the examination he is on inpatient treatment( from the department of cardiology, endocrinology, surgery, etc.).Early in the morning the patient comes to the department of functional diagnostics, he is invited to go to the office, where the doctor is instructing about the forthcoming study. Next, the patient is placed on the skin of the front chest wall electrodes( 5 - 7 depending on the model of the device) using disposable stickers reminiscent of an ordinary adhesive plaster. These electrodes are connected to a portable device that is worn on the chest or on the belt. In the case of a bifunctional( double) study, when the ECG is monitored in conjunction with blood pressure, a cuff on the shoulder is also applied to the patient, also connected to the device. The whole installation procedure takes no more than 10 minutes without causing unpleasant sensations.

Then the patient is given a diary, where on the form in the form of a tablet it is necessary to mark the time and actions committed at this time, as well as pain or other uncomfortable sensations. That is, the patient must record for the day everything that happens to him - sleep, eating, walking, physical and psycho-emotional loads, work performance, rest period. It is mandatory to record the time of taking medication, since it is important for the doctor in terms of the effect of a drug on the function of the heart. During the study, you can not take a shower or a bath, as it is unacceptable to contact the device and electrodes with water.

After a day( or several days, depending on the doctor's appointment) the patient again comes to the same room where the doctor unfastens the electrodes from his chest, removes the cuff and takes the portable device, connects it to the computer and receives all the information already analyzed by the device itself. The doctor evaluates the findings and issues an opinion that should be forwarded to the treating doctor in the next few days for further correction of the treatment, if necessary.

After receiving the results, the patient can go home( if the findings do not reveal serious cardiac irregularities requiring immediate hospitalization) or to the department from which he was sent for examination.

Interpretation of the results of 24-hour monitoring

What will the patient read in the received study protocol? In addition to the above electrocardiograms and their brief descriptions, an opinion is printed in the form, which indicates the following parameters:

- type of monitoring - ECG, AD, or both
- the total number of heart rate( HR) - reaches hundreds of thousands or more per day
- sinus or nonsinus( with atrial fibrillation, atrial flutter, for example) rhythm
- maximum and minimum heart rate per day
- mean daily heart rate and its type( tachy-, normo- or bradisystole, which means rapidity, normalheart rate, or rare heartbeat, respectively)
- characteristics of the heart rate - response to the load( normally should be adequate - increase within acceptable limits), a decrease in heart rate at night, whether or not submaximal heart rate is reached( 75% of maximum, achieving it means good tolerabilityphysical activity, unreachability indicates the occurrence of ischemia with minor loads)
- level of exercise tolerance - high, medium or low
- rhythm disturbances are described, if they are detected, napIma, ventricular or supraventricular extrasystoles, single, paired or group, tachycardia runs are indicated, if there is an
, changes in the blood supply of the myocardium are described, for example, disturbances in repolarization processes, or episodes of ST segment elevation or depression, signs of myocardial ischemia,time arise and are associated with the load, whether accompanied by pain, dyspnea, or other subjective symptoms.

Are there any complications during monitoring?

No, the test procedure is absolutely safe for the patient, so complications do not arise.

Doctor therapist Sazykina O.Yu.