Holter monitoring: price, conclusion, interpretation of results, indicators of the norm

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Holter examination is a continuous recording of the heart, recording of an electrocardiogram, a special complex method of instrumental and electrophysiological diagnostics. It is also called: "dynamic electrocardiography", "outpatient ECG monitoring", however, the medical term "Holter monitoring" is common - in honor of the inventor - Holter's biophysics. So, today we will talk more about Holter monitoring of ECG and AD, reviews about it, the system and the conclusion after the procedure.

What is Holter monitoring

The method of examination allows for continuous monitoring of cardiac activity with fixation on a cardiogram and using a compact holter device, which is impossible with other methods of cardiac diagnosis. Monitoring allows for a long time to observe changes in the functions of the myocardium, deviations in blood pressure indicators in the usual behavior of the patient for 12, 24, 48, 72 hours or more.

Advantages over standard ECG:

• continued monitoring of myocardial function;
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• assessment of cardiac activity in different types of exercise and at rest;
• fixes the most insignificant abnormalities, which are rare, due to continuous cardiography.

Next, we will tell you about the indications for holter monitoring of the heart.

In the next video, a cardiologist will tell more about the features of Holter monitoring:

To whom he is appointed

Holter research is prescribed when it is required to obtain objective accurate, complete information about the functioning of the myocardium. Holter's procedure is prescribed in such cases:

• to patients with normal ECG parameters, but experiencing cardiac pain of unknown origin, temporary rhythm failure that occur sporadically;
• in situations with sudden development of strong palpitation, dizziness, loss of consciousness;
• if necessary to confirm or exclude a diagnosis if there is a suspicion of myocardial ischemia( disturbance of blood flow in the coronary vessels);
• it is necessary to monitor a patient with the threat of severe ischemia and atrial fibrillation - monitoring will allow to establish the degree of blood supply to the heart tissues, frequency, force, rhythm of myocardial contractions;
• for monitoring the patient's condition with a confirmed diagnosis of heart disease, heart failure, survived myocardial infarction;
• control of pressure fluctuations - hypertension in moderate, severe degree, not amenable to therapy;
• for the analysis of the success of the treatment, determining the stability of the result of the prescribed therapy;
• for the purpose of checking the operation of the pacemaker installed in the patient( rhythm driver).

For what and how often it is necessary to undergo the procedure

With such problems with the heart, such manifestations as pain, burning, arrhythmia, constriction, palpitation often develop not at a particular time of the day or evening, but spontaneously. During the removal of the electrocardiogram, there is often nothing pathological. The problem remains, because the record was made at a time when there were no abnormalities and pains.

The standard cardiogram is a "short record" of the myocardium. Depending on the capabilities of the cardiograph, the "behavior" of the heart is fixed for several strokes - from 3 to 20. And for a day the muscle is reduced almost 100,000 times.

In such cases it is advisable to appoint Holter monitoring procedure. With any disorders of cardiac activity, tachycardia attacks, pauses and interruptions, ischemia, angina, the threat of a heart attack, sudden pressure surges, the procedure will enable the doctor to clarify the diagnosis and prevent many diseases. Repeated monitoring is carried out in case of distortion of results or their insufficient accuracy if it was not possible to "catch" deviations.

About daily Holter monitoring of ECG and AD, other forms of it we will talk below.

Types of

The survey has several types of

1. Complete, multi-day monitoring ( 1-7 days) is a common type of Holter procedure for long-term recording of heart parameters. During the study, free-moving patients using a device for continuous recording of electrical heart signals register up to 100,000 contractions over a long period. This makes it possible to detect violations that "did not have time" to fix for a short time the standard cardiography in the dispensary.
2. Large-scale ultra-long-term monitoring of lasting from 1 to 12 months, performed using a special recorder - a subcutaneous implant( Reveal XT).The device works up to 2 years, ECG registration is activated by the patient or by the device itself according to the programmed criteria. The registrar stores all data on the cycles of the myocardium during arrhythmia or pain. This function is optimal if the patient forgot to activate the ECG registration button.
3. Fragmentary( eventual) monitoring of .Information on the parameters of the heart periodically comes from the device, and the patient sends them for analysis to a specialist on their own. It is carried out in two ways:

• • the first option provides for continuous registration, when the device records the performance of the myocardium in a continuous mode;
  • another method is designed to activate the device by the patient to record ECG in the event of negative sensations in order to detect rare but clinically significant events. The principle is simple - with a feeling of heart rhythm disturbance, the patient presses the button on the device and immediately the ECG is removed. The entry for decoding is transmitted to the cardiologist. Such a Holter examination allows us to purposefully identify cardiovascular pathologies when specific abnormalities felt by the patient occur. Devices for fragmentary monitoring are small, imperceptible when carried. They are used as easily as a clock, a pedometer, a mobile phone.

To decipher and analyze the registered cardiogram were accurate and informative, a special diary is kept where the patient records the time of occurrence of any unpleasant sensations in the work of the heart, their degree and nature.

Indications for

Holter monitoring of ECG is an informative and reliable way of diagnosing cardiovascular pathologies. The procedure is shown when it is necessary to observe when:

• irregularities in the rhythm, violations of cardiac conduction;
• of unclear syncope, dizziness for unknown reason;
• at sensations of an uneven palpitation, too strong frequent jerks;
• ischemia( impaired blood flow) of the myocardium;
• soreness, compression of the sternum, typical for angina, or - atypical permanent, periodic pain, severity, arising suddenly or with emotional and physical stress, when it is impossible to exclude or, conversely, to confirm the diagnosis of angina pectoris;
• dyspnea, severe breathing difficulty;
• increased incomprehensible weakness in the morning, and abnormal sleepiness during the day;
• in case of suspected vasospastic angina( provoked at rest by spasm of the heart vessels, manifested on the ECG as a rise of the segment S-T);
• registration of "mute" myocardial ischemia, passing without pain symptoms;
• disorders of contractile function of the myocardium in patients:
  • who underwent infarction with the pathology of contractions of the left ventricle;
  • with cardiomyopathies - dilated( with dilated heart chambers and reduced possibility of contractions) or hypertrophic( with massive hypertrophy of ventricular walls, a decrease in cardiac output);
  • having heart defects.
• before surgical operations in elderly people with symptoms of cardiac pathologies.

Thanks to long-term monitoring and ECG recording it is possible to detect, in a timely manner, the development of cardiovascular pathologies such as:

• different forms of cardiac arrhythmias;
• angina( including "asymptomatic");
• hypertension with left ventricular hypertrophy;
• is ischemic heart disease.
• increased pressure in the lungs with signs of pulmonary insufficiency.

In addition, the survey is conducted to:

• determine the effectiveness of the therapy from arrhythmia, ischemia;
• analysis of results after surgery, laser ablation in pre-excitation syndrome( disorders in the conduction system of the heart, causing paroxysmal tachycardia);
• assessing the effectiveness of stenting, bypassing the coronary arteries;
• tests of pacemaker functions;
• monitoring of patients with a high probability of developing dangerous forms of arrhythmia or life-threatening ischemia, for patients to prevent secondary myocardial infarction.

More details about the benefits of the holter examination and indications to it will be told by the video below:

Contraindications for XM

Contraindications to Holter monitoring are not revealed.

Safety of such diagnostics

Over the years, Holter's procedure has collected a huge amount of statistical medical data that indicate the safety of monitoring. But there are limitations:

1. It is forbidden to be close to electrical devices, equipment, transformer booths, power lines.
2. Do not allow liquid to enter the appliance. In the event of water falling on the device, it is necessary to interrupt the study.
3. Do not allow the instrument to overheat or strongly cool so that monitoring data is objective and accurate.
4. Do not expose the device to vibrations, vibration, or mechanical damage.
5. Heavy physical exertion is not recommended, this causes incorrect results and possible detachment of electrodes.
6. Do not allow the device to come into contact with reactive media.
7. It is necessary to sleep on the back, it is allowed - on the side, but when lying on the stomach electrodes are shifted from the place.
8. Wear clothing made of natural fabrics that do not cause static electricity.

Carrying out the

procedure Preparing the

The removal of a long cardiogram according to Holter does not require special preparation. For contact with the skin, the adhesive electrodes of the recorder are used. To get accurate qualitative information, in the place of the electrode stickers shave off the hair and degrease the skin with alcohol.

The doctor sometimes gives the assignment: to climb the stairs to a specific floor and make a note by pressing a key on the monitor of the device. So you can analyze the changes in the work of the heart at a certain load.

Before the procedure follows:

1. Take a shower, as during the survey this can not be done.
2. Remove from clothing and body metal rivets, buttons, ornaments.
3. Inform the doctor of the name and mode of taking the medication.

How everything passes

Holter examination is a continuous recording of an electrocardiogram for a long time. Recording is carried out by a special apparatus, which is worn on a belt, more often on a belt.

The procedure is not tedious, safe and completely painless. The cardiologist attaches flat adhesive sensors from the ECG recorder to the chest in an amount of 5 to 12 pieces attached to the device. In the case of a bifunctional examination, if heart monitoring is performed together with monitoring blood pressure parameters, the patient is placed on the shoulder with a cuff, also connected to the recorder. Installation procedure lasts no longer than 10 minutes.

During the examination, the patient is given a diary, where he records:

1. Type of activities during wakefulness( watching TV, working at a computer, machine, walking, reading, sports, physical stress, psychological stress).
2. Time of rest, sleep, change of type of activity.
3. General condition, circumstances and exact time of development of specific sensations in the work of the heart: interruptions, rapid heart rate, shortness of breath, pain, fainting, dizziness.

In the diary necessarily mark the beginning and the end:

• night and daytime sleep;
• physical activity and its appearance;
• psychological stress situations( expectation, nervousness, quarrel, a strong experience);
• eating and medication.

The duration of the examination is determined by the cardiologist, based on the monitoring goals and objectives. The greatest number of extrasystoles in ventricles that threaten life is found in 6 to 12 hours of follow-up. Ventricular tachycardias require a longer examination - during the day.

To detect the causes of unconsciousness or fainting, monitoring is necessary for about 24 hours. With an increase in the duration of registration to 3 days, the percentage of blockade of the heart increases by 300%.

The results of Holter monitoring of ECG and their decoding will be described later.

Decoding of results

The analysis of the electrocardiogram record made on the recorder is done on decoder computers with a special program. The modern portable holter-registrar is able to independently carry out the initial classification of the ECG, accelerating the process of final decoding by a cardiologist.

All information from the device is entered into the computer together with the data from the diary. The program organizes and conducts primary information analysis, displaying an electrocardiogram for a day. Any classification of ECG, which is carried out automatically by the registrar, has inaccuracies, therefore the correction is corrected by a specialist. Based on the analysis and the final processed and corrected information, a conclusion is written.

In addition to the descriptions, the patient is given a conclusion. The "standardized" wording of the standard for decoding the ECG Holter has not yet been created, but the description necessarily specifies:

• type( continuous, fragmentary) and type of monitoring - ECG, blood pressure or a combination thereof;
• frequency of myocardial contractions - the total, for all time, heart rate per day - the maximum and minimum;
• mean heart rate during the day and its type( tachysystole - rapid heart rate, normosystole - normal, bradisystole - rare);
• parameters of cardiac muscle contractions with response to the load:
  • is normal - the increase may be within the allowed values;
  • achievement of "submaximal" - 75% of the maximum - heart rate indicates good tolerance of physical stress, not achievement - a sign of possible development of ischemia under low loads);
• rates of heart rate reduction during night sleep;
• high, medium, low level of endurance( cardiac endurance) of physical activity - tolerance;
• information on the rhythm of the heart: sinus( normal) or not sinus( often manifested with atrial fibrillation);
• data on detected rhythm disturbances: extrasystoles( indicating species - single, paired, group, number of episodes of tachycardia), paroxysmal arrhythmias;
• data on segment changes on the PQ, QT cardiogram, QRS abnormalities provoked by the intraventricular conduction disorder;
• information on possible violations of myocardial blood supply - ventricular repolarization processes( ST segment) - episodes of ST rise or fall indicate possible heart muscle ischemia. Data on the connection of these abnormalities with physical exertion and accompanying them with shortness of breath, pain, and other subjective signs according to the diary are necessarily recorded;
• information on the functioning of the pacemaker - if it is installed in the patient.

Detected deviations, pathologies are supplemented with printouts of electrocardiograms for the entire period of the survey. In the field of Holter monitoring, cardiologists work with great practice. As a rule, after the analysis of electrocardiograms and diary, the conclusion is given to the patient within half an hour. If necessary, promptly appointed effective treatment.

In conclusion - a few words about the cost Holter monitoring ECG.

Average cost of procedure

Approximate average prices for Holter ECG monitoring in the Russian Federation in rubles:

• Setting of the device - 420
• Daily Holter monitoring of ECG( 24 hours) with removal of the device and interpretation of the study - 3000.

The following video will tell you about Holtermonitoring in the child: