Daily ( Holter ) monitoring of ECG and blood pressure - Causes, Symptoms and Treatment .MF .
Prepare and process monitoring
At the heart of the heart muscle is carrying on its electrical impulses that cause the contraction of muscle cells.This phenomenon has been studied and is the basis for registration of various diseases of the heart with a device called the electrocardiograph - apparatus for recording an electrocardiogram (ECG).If there is in the heart of pathological processes identified ECG changes characteristic of certain diseases (coronary heart disease, arterial hypertension and others).
But not always a complete picture of a particular disease can be obtained by carrying out only a standard ECG, as there are latent (hidden, "dumb") forms of heart disease does not manifest itself clinically and recorded on an electrocardiogram on a background of physical activity.For the diagnosis of diseases such forms are used with ECG exercise (treadmill test, bicycle ergometry), as well as daily monitoring of ECG Holter
ECG monitoring - is an instrumental method for the diagnosis of diseases of the cardiovascular system, based on the registration within a day of electrical activity that occurs during the activity of the heart muscle (myocardium) and varies depending on the presence of certain diseases of the heart in a patient.
The essence of this method developed by American scientist Halter is this - the patient by a physician on chest mounted electrodes that read the information on the work of the heart and connected to a portable device, where the data processing takes place and recording them as graphic curves -electrocardiograms, stored in the device memory.If a patient simultaneously superimposed cuff shoulder (analogue of the usual apparatus for blood pressure measurement - a tonometer), then the monitoring enables dynamic measurement of blood pressure oscillometric per day (e) manner.
In diagnostically ambiguous cases, research can be extended to seven days, if the first 24 hours was not successful registration of pathological changes on ECG, and the patient's symptoms continue to bother about which was prescribed and tests.
device for Holter ECG
ECG monitoring and blood pressure Holter has a number of advantages over standard ECG and conducting ECG with physical activity, since a single ECG carried out in a state of rest, and lasts for a few minutes, can not always beregister myocardial ischemia or paroxysmal (paroxysmal) arrhythmias.Also, the method allows the ECG recording in a state of normal household activity, for patients with habitual physical activity, which is important for the correction of the treatment of patients in whom there is a deterioration of the heart with minimal activity.Additionally, the method can be noted availability, ease of study, not invasive (no damage body tissues).
indications for Holter monitoring
This method of research applied in the following cases:
1. Diagnosis of coronary heart disease (coronary heart disease)
- Prinzmetal angina (vasospastic),
- painless ( "dumb"), myocardial ischemia,
-stable and unstable angina,
- myocardial infarction, particularly its form painless
- condition after suffering sudden cardiac death
2. Diagnosis of hypertension
3. Diagnosis of cardiac arrhythmias
- sick sinus syndrome,
- Wolff - Parkinson -White (ERW - syndrome),
- long QT syndrome,
- atrial fibrillation,
- AV - block, sinoatrial block,
- ventricular tachycardia
heart - to diagnose arrhythmias, frequently accompany the acquired heart diseases,particularly mitral valve
5. Routine inspection
- persons subjected to surgery on the heart and other organs
- patients with diabetes (diabetic angiopathy - vascular pathology, including coronary)
6. Monitoring the effectiveness of the treatment
- antiarrhythmic andantianginal (angina),
- cardiac surgery in ischemic heart disease (coronary artery stenting, coronary - coronary artery bypass grafting) and arrhythmias (radiofrequency, laser ablation - the destruction of accessory pathways in the heart, the installation of an artificial pacemaker and monitoring its work effectively),
- appointmentand assessment of the effectiveness of antihypertensive (blood pressure lowering) drugs.
Monitoring the Holter can be assigned when the following symptoms in a patient:
- pressing or burning pain behind the breastbone and in the heart, with or without irradiation (placed under the left shoulder, the left arm or not);
- pain in the left side of the rib cage of a character, with a clear link to physical activity or without it;
- characteristic pain in the heart at night (usually in the early morning) hours - typical for angina Prinzmetal;
- feeling short of breath, episodes of severe shortness of breath with a suffocating cough;
- periodic disruptions of the heart, a sense of fading heart;
- frequent dizziness and / or fainting.
Contraindications for daily monitoring
At present contraindications for the study are not available.But the study, some patients may be technically not feasible, for example when heavy chest injuries, extensive wound or burn on the skin surfaces of the chest, with very pronounced degree of obesity.
Prepare patient for Holter monitoring of blood pressure and ECG
For this study, patients do not need to specially prepared.The day before, you can eat or drink in the usual amounts, in the morning before the procedure allowed a light breakfast.Alcohol should be eliminated and coffee, as well as reduce the number of cigarettes smoked, since these products can significantly affect the contractility and function of cardiac muscle conductivity.
How is the research?
patient may be referred to the procedure as from the clinic and the hospital department, which at the time of the survey is hospitalized (department of cardiology, endocrinology, surgery, etc.).Early in the morning the patient comes to the department of functional diagnostics, he was invited to go to the office, where the doctor conducts briefing on the upcoming study.Next, the patient on the skin of the anterior chest wall mounted electrodes (5 - 7 depending on the device model) with the help of disposable labels that resemble an ordinary plaster.These electrodes are connected to a portable device, which is worn on the chest or waist.In case of the bifunctional (double) study, when carried out in conjunction with the ECG monitoring of blood pressure, the cuff is applied to the patient's shoulder, also connected to the device.The entire installation process takes no more than 10 minutes without causing discomfort.
Next, the patient is given a diary where on the form in the form of tablets is necessary to mark time and action taken in this period, as well as pain or other discomfort.That is, the patient must fix a day everything that comes with it - sleep, eating, walking, physical and psycho-emotional stress, performance of work, rest period.Compulsory fixed time medication, as this is important for the physician in terms of the influence of a drug on the heart function.Throughout the study, it is impossible to take a shower or bath, since the device is not allowed contact with water and electrodes.
After a day (or several days, depending on the doctor's prescription) patient comes again in the same room, where the doctor peels electrodes with his chest, removes the cuff and picks up the portable device, connect it to your computer and get all the information already analyzed by thedevice.The doctor evaluates the data and provides the conclusion that in the near term to be handed over to the attending physician for further treatment if necessary correction.
After receiving the results of the patient can go home (if the data did not reveal any serious violations of the heart, requiring immediate hospitalization) or to the department from which was sent for examination.
Deciphering the results of daily monitoring
As read in the patient received the study protocol?In addition to the above ECG, and a brief description, in form printed report, which shall contain the following parameters:
- monitoring type - ECG, blood pressure, or both
- the total number of heart rate (HR) - up to about a hundred thousand or more perday
- sinus or nesinusovy (for atrial fibrillation, atrial flutter, for example) rhythm
- maximum and minimum heart rate per day
- average heart rate and type (tachy, standard-setting or bradysystole, which means rapid, normal or unusual heartbeat, respectively)
- characteristics of heart rate - a reaction to the load (normal should be adequate - an increase in the range of valid values), heart rate reduction at night, is reached or not submaximal heart rate (75% of the maximum, achieving it is a good exercise tolerance, failure to saysthe occurrence of ischemia at low loads)
- level exercise tolerance - high, medium or low
- described rhythm disturbances, if they are detected, such as ventricular and supraventricular arrhythmias, single, pair or group, indicated jog tachycardia if there
- describes the changes in the blood supply to the myocardium, such as violations of repolarization, or episodes of depression or rise (decline) segment ST - signs of myocardial ischemia, at which time there, and whether the load, whether accompanied by pain, shortness of breath or other subjective symptoms.
whether complications are possible during the monitoring?
No, research is absolutely safe for the patient, so complications do not arise.
therapists Sazykina OJ