Holter Monitor
24 Hour Test For Heart Disease

Guide to Heart Monitors


Holter Monitor


What Is A Holter Monitor?
What's The Difference Between Holters And Event Monitors?
How Is The Test Done?
When Will I Get The Results?
Why Is It Recommended?
Is The Test Safe?
Holter Monitor Diary
Holter Monitor Report
How Much Does The Test Cost?

Interesting Heart Facts:

Heart Disease Statistics
UK Heart Disease Statistics

Back To Main Guide:

Heart Disease In Women
What Is A Holter Monitor?

A Holter Monitor is a small portable device used for heart disease testing and for the assessment and diagnosis of chest pain. It is worn for a period of time to record the heart's rhythm (electrocardiogram, EKG or ECG) - although it can also be used for monitoring brain activity (electroencephalography or EEG). The device incorporates electrodes which are strapped to the chest and connect by wire to a monitor which records the heart’s activity. A Holter is usually worn for 24 to 48 hours and helps to diagnose heart arrhythmia, palpitations and causes of dizziness, chest pain and black out spells.

As the heart is continuously monitored over a period of 24 hours or more it has a better chance of detecting a problem than an external electrocardiogram which only records the heart for a few seconds. A Holter is also known as an ambulatory electrocardiography (AECG) device. An Event Monitor is another type of AECG device which is used to record the heart's condition. However unlike the Holter, it is worn for 30 days or more and records intermittently, not continuously.

What's The Difference Between Holters And Event Monitors?

The Holter Monitor records continuously for a period of 24 to 48 hours, whereas an Event Monitor records on a Loop or is only activated by the patient when symptoms occur. Continuous AECG recording (Holters) are more useful if symptoms occur on an almost daily basis. A Holter Monitor is more likely to be used where symptoms are serious and more immediate. It may also be used to monitor a patient in the 24 hour period after a heart attack (technically called myocardial infarction) before hospital discharge. However as many patients only experience symptoms on a weekly or monthly basis, a single continuous AECG recording is unlikely to capture any useful information. An intermittent recorder (Event Monitor) is more useful in this instance. However patients who experience blackouts or fainting spells are unlikely to be able to activate an Event Monitor in time. Instead they may be recommended the newer long-term recording device which can be implanted under the skin (Implantable Loop Recorders).

How Is The Test Done?

If your doctor orders a Holter test he (or the hospital) will organize the equipment for the duration of the test. Electrodes which look like sticky patches will be placed on the skin of your chest. Extra bandages may be placed over the patches to keep them in place. Each electrode has a wire attached to it, which is then connected to a monitor the size of a portable tape player. It is worn on a belt or shoulder strap. Once the device is switched on, it will continuously monitor the heart for the duration of the test. You will also be asked to keep a Holter Monitor Diary to record what you were doing when any symptoms occurred. When the test is completed you will be asked to return the monitor to the hospital. A technician will take the recording and uses special computer software to download and analyze the results. The Holter monitor has an internal clock which stamps the time on special EKG strips. The technician will compare the strips with symptoms recorded in the patient's diary. He then prepares a full report (see below) for the doctor to interpret.

When Will I Get The Results?

The report can take a few days to generate and reach your doctor. However if the technician notes a potentially dangerous rhythm then the doctor will be notified immediately. Based on the report, treatment may be recommended. For example, patients who experienced symptoms of coronary heart disease such as blackouts and extremely slow heart beats may be recommended a pacemaker. A ‘normal’ result is one which shows normal heart rate variations which should change according to the sorts of activity the patient undertook at the time. This is where the diary is important.

Why Is It Recommended?

A test may be recommended for the following reasons:

To assess chest pain which cannot be reproduced with an exercise stress test.
To evaluate other signs associated with heart disease and coronary heart disease such as dizziness, fatigue, shortness of breath and blackouts (fainting).
To assess irregular heartbeats and palpitations.
To check for signs of possible future congestive heart failure.
To assess if an installed pacemaker is functioning properly.
To assess if arrhythmia treatment therapies are working.
To check the heart's function directly after a heart attack.
To determine if an implantable cardioverter defibrillator is necessary.
To diagnose atrial fibrillation/atrial flutter.
To diagnose multifocal atrial tachycardia or paroxysmal supraventricular tachycardia
To diagnosed slow heart rate (bradycardia) or ventricular tachycardia.
It it not meant to test blood pressure, to do this, you'd need to use a home blood pressure monitor.

Is The Test Safe?

Yes, it is safe - there are no risks associated with Holter Monitors. It may be a little uncomfortable to wear, particularly in bed but this is only a minor problem considering the diagnostic benefits of the device. No showering is possible. In order to ensure an accurate reading, you will be advised to stay away from electric blankets, magnets, metal detectors and high voltage areas. Some people may experience a slight skin irritation when the electrodes are removed. Scientists are currently researching new types of sensors which do not require skin contact, including sensors that can be embedded in a thin vest.

Holter Monitor Diary

While being monitored it is very important to keep an accurate diary of your activities and symptoms as they occur. If you feel any signs of uneven heartbeats, fainting, dizziness, shortness of breath or chest pain, note it in your diary, along with the time and activity being performed at the time. The diary will later be compared with a computer printout of the ECG recordings. To check the signs, read chest pain in women.

Sample Diary

Holter Monitor Report Interpretation

The following is an example of a report which the clinician will complete once they receive the Holter back from the patient. It will be given to your doctor who will then need to determine if further testing, monitoring or treatment is necessary.

Patient Name:

Recording Time
Hours __ Minutes __.

Recording Quality
Is one of the following: Excellent/Good/Fair/Poor.

Basic Rhythm
Is one of the following: Sinus Atrial Fibrillation/AV paced/VVI paced/A sensed V paced.

Heart Rate Range
From __ to __ bpm (average bpm is __).
Note: A healthy bpm is between 60 and 100 bpm.

Heart Rate
Maximum Heart Rate Occurred at __. Minimum Heart Rate occurred at __.
Average Hourly Heart Rate was more than 100 bpm from __ to __.
There were no or __ pauses. The longest was __ seconds and occurred at __.

Premature Atrial Contractions (PACs) were: absent/rare/occasional/frequent. (Average __ per hr. Total recordings were __).
Range __ to __ per hour.
There were no or __ episodes of supraventricular tachycardia (SVT) ranging from __ to __ beats. The fastest rate was __ bpm.
SVT appeared to be: atrial fibrillation/atrial flutter/AVRT/AVNRT/atrial tachycardia/uncertain.
Note: Premature atrial contraction may feel like skipped heart beats. Most PACs are harmless and do not require further treatment. However if they are found with other heart problems, it may be an indication of something more serious.

Premature Ventricular Contractions (PVCs) were: absent/rare/occasional/frequent. (Average __ per hr. Total recordings were __).
Range __ to __ per hour.
Episodes of atrial bigeminy were: rare/occasional/frequent.
Episodes of trigeminy were rare/occasional/frequent.
There were no or __ atrial couplets. (This can be an indication of atrial fibrillation).
There were __ episodes of ventricular tachycardia (VT) ranging from __ to __ beats with rates up to __ bpm.
The longest episode occurred at __.
Note: Premature ventricular contractions abnormal heartbeats which can be caused by high blood pressure, heart attacks, cardiomyopathy, heart valve disease and certain medications.

The diary was/was not returned.
It was returned and reported symptoms of :
Rhythm strips show the following symptom __ at __ (time).
Rhythm strips show the following symptom __ at __ (time).

Overall Impression
Clinician will mark one of the following possible outcomes of the test:

1. No remarkable findings.
2. Elevated average hourly heart rate suggests presence of sinus tachycardia, excess catecholamines, deconditioning or possible drug effect. Further clinical tests needed.
3. Tachycardia to __ bpm with pauses to __ seconds. Suggests the possibility of tachy-brady syndrome.
4. Wenckebach (type 1 second degree AV block) appears to be slowing the heart beat. This condition is almost always a benign and no specific treatment is needed.
5. Symptoms of __ are in excess of ectopy (disturbances of heart rhythm) recorded.
6. Atrial/ventricular ectopy appears to exist.
7. Symptoms of __ appear to be associated with __.

Important: Know the Risk factors for heart disease in Women.

How Much Does The Test Cost?

The average price for Holter monitoring testing in the United States is about $350 and about €170 in Europe.

Other Types of Heart Tests
Nuclear Heart Scan
Heart Catheterization
Coronary Angiography
Calcium Score Test
Chemical Stress Test

  Related Articles on Heart Disease Testing

For more information, see the following:

Angina Attack Explained / Cardiac Rehabilitation
Cardiac Rehab Exercise Program

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