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Holter Monitor

By

Catherine Spader, RN

What is a Holter monitor?

A Holter monitor is a painless test that records your heart’s electrical activity continuously for one to two days. A Holter monitor is a longer version of an EKG (electrocardiogram). It helps your doctor diagnose and monitor abnormal heartbeats (cardiac arrhythmias) and decreased blood supply to the heart muscle (myocardial ischemia). 

A Holter monitor can detect abnormal heartbeats and other abnormal EKG changes that a standard EKG can miss. Standard EKGs only record the heart’s electrical activity for a short period of time. A continuous Holter monitor is more likely to detect abnormalities that occur periodically. 

A Holter monitor is only one method used to monitor and diagnose heart conditions. Discuss all of the options for evaluating heart health with your doctor to understand which options are right for you. 

Why is a Holter monitor performed? 

Your doctor may recommend a Holter monitor to evaluate your heart health. It provides important information about your heart health in relation to your age, physical exam, medical history, and other tests. A Holter monitor by itself cannot diagnose all types of heart conditions or predict future heart problems.

Your doctor may recommend a Holter monitor to diagnose, determine the severity of, and guide treatment of these conditions:

  • Cardiac arrhythmias including heartbeats that are too fast, too slow, or irregular, especially arrhythmias that do not occur all the time 

  • Coronary artery disease (CAD), a buildup of plaque on the walls of the coronary arteries that supply blood to the heart. CAD can cause poor blood flow to the heart muscle, called ischemia, and chest pain, called angina. A Holter monitor is useful in detecting ischemia when there is no chest pain or other symptoms.

A Holter monitor can also help determine if certain symptoms are related to a heart problem. Symptoms include chest pain, dizziness, shortness of breath, fatigue, weakness, palpitations, passing out, or feeling a pounding, racing or irregular heartbeat.

Who performs a Holter monitor?

A nurse or technician will set up your Holter monitor. The following doctors order and interpret Holter monitor testing: 

  • Cardiologists specialize in diagnosing and treating diseases and conditions of the heart and its blood vessels.

  • Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.

  • Electrophysiologists are cardiologists who specialize in treating heart rhythm disturbances (arrhythmias).

  • Interventional cardiologists are cardiologists who specialize in diagnosing and treating heart disease using catheter procedures and radiological imaging

  • Pediatric cardiologists specialize in diagnosing and treating diseases and conditions of the heart and its blood vessels in children.

How is a Holter monitor performed?

Your Holter monitor will be applied in a medical setting. Testing generally includes these steps:

  1. Your provider will attach three or four sticky, painless patches, or electrodes, to your chest. Your provider will shave small areas of your chest if needed. The electrodes are attached to a Holter monitor device by wires. The monitor is about the size of a Smartphone. You wear it clipped to a belt or carry it in a pouch slung over the neck or shoulder.

  2. You will likely go about your normal activities during your Holter monitor test. Doctors sometimes limit activities or provide specific instructions for activity level.

  3. You may need to press a button on the Holter monitor if you have symptoms, such as chest pain, dizziness, or a racing or pounding heart. This will help your doctor evaluate your results by marking the exact time of symptoms.

  4. You may keep a log of all your activities and any symptoms.

  5. At the end of your Holter monitor test period, you will remove the electrodes and return the device and your activity log to your doctor. The test period is usually 24 to 48 hours long.

  6. Your doctor will evaluate the Holter monitor results and discuss them with you.

What are the risks and potential complications of a Holter monitor?  

A Holter monitor is a safe procedure. Some people may have minor skin irritation from the sticky electrodes. This generally goes away after removing the electrodes.

How do I prepare for my Holter monitor?

There is no special preparation needed for a Holter monitor test. It is a good idea to wear a loose fitting, button-down top for comfort and convenience during the test period.

You may want to bath or shower right before a Holter monitor test. You cannot shower during the test period because water damages the device.

Questions to ask your doctor

It is common for patients to forget some of their questions about a Holter monitor during a doctor’s office appointment. Contact your doctor with concerns and questions before Holter monitor testing and between appointments. 

It is also a good idea to bring a list of questions to your appointments. Common questions include:

  • Why do I need a Holter monitor test?

  • How long will I wear the Holter monitor?

  • How should I take my medications before and after my Holter monitor test?

  • What kind of activities can I perform during the Holter monitor test?

  • What activities and symptoms do I need to document in my Holter monitor log?

  • When and how can I expect to get my results?

  • What other tests do I need?

  • When should I follow up with you?

  • How should I contact you? Ask for numbers to call during and after regular hours.

What can I expect after my Holter monitor test?

Knowing what to expect after your Holter monitor test can help you get back to your everyday life as soon as possible. 

How will I feel after my Holter monitor test?

You should not feel any ill effects or symptoms after your Holter monitor test. Tell your doctor or provider right away about any symptoms, such as dizziness, chest pain, palpitations, racing heart, or shortness of breath. 

When should I call my doctor?

It is important to keep your follow-up appointments after your Holter monitor test. Contact your doctor for questions and concerns between appointments or if you have any symptoms that are new, unusual, or are not responding to your medications. Seek emergency medical care or call 911 if you have chest pain or shortness of breath.

Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Sep 11, 2016

© 2017 Healthgrades Operating Company, Inc. All rights reserved. May not be reproduced or reprinted without permission from Healthgrades Operating Company, Inc. Use of this information is governed by the Healthgrades User Agreement.

View Sources

Medical References

  1. Ambulatory Electrocardiogram. American College of Cardiology. http://cardiosmart.org/HeartDisease/CTT.aspx?id=716.
  2. Electrocardiogram (ECG). Bupa. http://www.bupa.co.uk/individuals/health-information/directory/e/electrocardiogram
  3. EKG or Electrocardiogram. HeartSite.com. http://www.heartsite.com/html/ekg.html.
  4. ECG library. ecglibrarycom. http://www.ecglibrary.com/ecghome.html.
  5. Holter Monitor. HeartSite.com. http://www.heartsite.com/html/holter.html.
  6. Holter Monitoring. Texas Heart Institute. http://www.texasheartinstitute.org/HIC/Topics/Diag/diholt.cfm.
  7. What Is an Electrocardiogram? National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/ekg/.

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