Holter monitor to the rescue when a heart goes rogue.

A few weeks ago, I continued to get an irregular heartbeat icon when I took my blood pressure.  When I took my pulse and felt in the area of my heart, it seemed like I was detecting an extra heartbeat.  Oh great, just when I thought I was making progress on my treatment, my heart decides to go rogue.  I guess it was tired of doing the waltz and wanted to insert some extra beats for a samba. 

So what is a heart patient to do?  Avoid the tendency to be anxious and procrastinate as this might cause even more heart disruption.  Instead, I decided that I needed to use the extra beats to spring into action!  I got in contact with the office of my electrophysiologist (the doctor who put in my cardiac device) and they set up an appointment.  He also requested that I wear a holter monitor for 24 hours so he could get a snapshot of what my heart was doing.
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So you may be wondering – what is a holter monitor, and is it a risky or painful process?  The answers are no and no.  As a matter of history trivia, the Museum of American History’s website  has a great November 16, 2011 blog post, which should get points just for the title:  At the Heart of the Invention:  The Development of the Holter Monitor. 

This monitor was apparently the invention of Norman “Jeff” Holter and Bruce Del Mar.  The article does not state why the monitor is named after Holter and not Del Mar.  But  the post is a fascinating account of their quest to continually monitor heart activity for an extended period of time.  The post says that the initial broadcast of “a radioelectrocardiogram (RECG) took place circa 1947 and required 80 to 85 pounds of equipment, which Holter wore on his back while riding a stationary bicycle.: 

Fast forward more than 70 years to a process that is much more portable!  Now the recording part of the monitor is no bigger than a camera and is lightweight.  The recorder is attached to your body by five electrodes, 4 which are placed under your chest and one which is placed in the center of the area above your chest.  Prior to placing the electrodes in these areas, the nurse will put a small amount of exfoliant on the skin to make sure that the electrodes stick and remain in place throughout the monitoring process.

The monitor had a button on it.  I was instructed to press the button when I felt an incident like a palpitation, an extra beat, shortness of breath or dizziness.  The recorder would then show the time of the incident, which is helpful because you need to note on a diary sheet the time and type of incident, and the activity you were performing at the time.  At this point, you are allowed to leave your doctor's office with the instruction that you turn the recorder and diary into the doctor’s office promptly after the monitoring period is over.  Once you turn these materials in, a record of monitoring will be compiled for the doctor to review.

One tip that I will give you is to make sure that you wear clothing that has one or more pockets to hold the recorder.  I did not have a pocket, so I had to clip the recorder to my capri pants which was okay, but I would have preferred to keep it in a pocket.  You might be wondering if the recorder is easy to spot.  Well, according to the Mayo Clinic’s website, you can easily hide the monitor.  I beg to differ if you happen to be a short and petite person.  The recorder is attached to a rather bulky cord that looks a bit like it should be plugged into an electrical outlet.  In my case, if I tried to hide it underneath my clothing it made a rather noticeable lump, so I just let it show outside what I was wearing.  I figured it was only for 24 hours so how bad could it be?  Along with my cardiac device, it became part of a very liberated yet honest heart fashion statement!

One of my concerns was what to do with the recorder device while I was sleeping.  A friend told me that she had put her recorder on the night table next to her bed.  My night table, however, has a Latitude monitor.  This is the device that periodically interrogates my cardiac device and sends data from the interrogation as well as from my scale to a monitoring center.  I do not have technical expertise to know if the devices would somehow interact or interfere with each other.  Since I have a queen size bed, I decided to just put the device on the other end of the bed and hope that I didn’t roll on top of it and set the event button off. 

Another unforeseen hiccup that I had to watch out for was the cord that was attached to the recorder and electrodes.  I went into my kitchen to get something and the cord got caught on a cabinet door knob.  Happily, I wasn’t moving really fast and the motion did not cause any of the electrodes to disconnect.  But going forward I was very careful moving around inanimate objects so that I wouldn’t derail my device.  As instructed, I noted big events such as sleeping, waking up and exercising.  I tried to exercise to my normal level so that the monitor would get a really good read of my heart in an active status.  I only noted two times that I felt something strange.  Once was when I felt a flutter in the heart area, and the other time came when I was getting ready to take the electrodes off.  I thought I felt an extra beat. 

I was happy to get the device off so that I could take a shower.  I was even happier that the monitoring period had only lasted 24 hours because in this hot weather it really helps to be able to unwind and refresh in a shower every 24 hours.  I noticed after I showered that I could still see where the electrodes had been placed, and it took a while for the suction marks to disappear.

When I was writing looking up holter monitors for this post, I saw that there are also things known as
event monitors and loop recorders.  I wondered what the difference was.  Since I was told to push the button on the recorder whenever I had an incident, I wondered if what I had was actually an event monitor?

The Johns Hopkins website has an article entitled What is an Event Monitor.  According to this article, the event monitor is a portable device used to record your heart’s electrical activity when you have symptoms. It records the same information as an electrocardiogram (ECG), but for longer durations of time.  When I saw this explanation, it did sound like it was the same device as my event monitor.  But then I read further, and found this distinction stated in the article:

• An event monitor is very similar to something called a Holter monitor. This is another portable device used to analyze the heart’s signaling. Holter monitors record continuously, usually for about 24 to 48 hours. An event monitor does not record continuously. Instead, it records when you activate it. Some event monitors will automatically start recording if an abnormal heart rhythm is detected. Event monitors can be worn for a month or longer.

So I believe that what I wore was a holter monitor because it was recording continuously to provide a 24 hour snapshot. 

When I got to the doctor’s office, the nurse made sure that a pacemaker interrogator was in the office.  That sounds intimidating but it is just a machine that the doctor can use to obtain current readings of heart activity from the heart.  I was allowed to stay in my street clothes and did not have to change into a medical gown.  This is because there is a little wand that is placed over my collar bone area to get the readings – it’s not like I had to wear any electrodes or other wires.

So here is what we found from the holter monitor.  Yes, I was having extra beats.  However, the percentage was not near the threshold that would indicate that my heart muscle was weakening.  So that was good news.  This means that there was no need for treatment which was even better news.  I also learned through the pacemaker “interrogation” that the battery life on my device is about 3 years.  When the battery wears out, then the entire device will have to be switched out for a new one which I believe requires a hospital stay but is routine. 

I was able to look at the pacemaker interrogator screen to see the heart beats.  There were little black blips that indicated normal heart beats.  Then periodically we would see a little red blip.  This was the irregular beat, often referred to as premature ventricular contractions or PVCs.  In most cases I was surprised because unlike some patients with this issue, I was only very occasionally feeling the irregular beat.  When I felt it, the sensation was like a flutter in the chest area. 

At this point in time, the irregular heartbeat symbol no longer continually appears on my blood pressure monitor.  When it does appear, it returns back to normal on the retake.  I have no idea what caused the spate of irregular heartbeat sightings.  Maybe my heart was on vacation and out late partying each night.  Next time I just ask that it invite me along for the festivities.  If I’m going to have to at some point be treated for a problem, I’d like to at least have participated in the adventures causing the problem.