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Experience with 24 hour (or longer) electrocardiogram/Holter monitor


Steven
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For those who have had a 24 hour electrocardiogram (EKG or ECG, depending where you are in the world), also known as a Holter monitor, I'm wondering what your experience was like in terms of the reported data and interpretation, especially if you meet the diagnostic criteria for POTS.

Did the reported data and interpretation catch or miss key features relevant to dysautonomia and POTS?

For those who don't have a separate heart condition, did it pick up much useful info or just things that got written off as 'probable normal variants'?

Was the reported data and interpretation mostly focused on the wrong details for dysautonomia and POTS, or did you actually get much of use from it?

I returned a 24 hour monitor yesterday and should have the report a week from now. They won't provide me a full copy of the data but will provide my doctor a report with some 10 second strips.

I was told that there will be a graph of the 24 hours, which should be useful - but the limited resolution of it being printed on A4 sized paper (and not necessarily a full-page, landscape-layout graph) could limit its usefulness a lot.

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I have had several with hypoPOTS and no other heart issues. None of my halter monitors have been considered to be anything significant. All I got out of it was, "yes, we see the tachycardia. That is the POTS showing." 

For me, I consider them useless and hate to wear them. Every time I go in the hospital for something unrelated, they slap one of those things on me and hang it around my neck. It gets in the way of the IV and the IV stand. If it never shows anything, why do I have to pay for it every time? Either there is nothing wrong with my heart or there is. You can't have it both ways. 

Can you tell they frustrate me? :wacko:

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When I wore a Holter monitor it picked up enough bradycardia and tachycardia that it led my GP to refer me to an electrophysiology cardiologist. He was the one who recognized my symptoms and diagnosed me properly. He then ran additional tests to confirm my diagnosis.

So the holter monitoring was very beneficial for me in that respect.

Now that I am diagnosed they do not hook me up to holter monitors anymore. They DO hook me up to do ekgs when they run occasional tests such as treadmill testing. 

Edited by Missy M
typos
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I was told my Holter was fine, except for the palpitations.  I was told to drink Gatorade and keep myself hydrated.  That was before my tilt.  I was not told that my tachycardia was abnormal.  But I think they had either ordered the tilt already or were thinking of doing it, so maybe they just didn't feel it necessary to go down that road yet, figuring they would know more after the tilt...?  I don't know.

I'm just saying that you can have POTS and be told your Holter is normal.  They don't see exactly what you are doing when your tachycardia is occurring (or what your BP is doing), so they don't know what exactly is going on just from the Holter readings.  It's a tool, but it has limited value.

 

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I had several holters - 24 hr, 48 hr, 30 days and then a implanted loop recorder that recorded EVERYTHING for 3 years until the battery ran out. The 24 hr one was the first one and actually recorded my very first syncopal episode: Sinus tachycardia in the 150's for 3 hrs. All the others showed tachycardia, PVC's (palpitations) and occasional atrial flutter ( not related to POTS ).  The monitors are very helpful even if they do not show anything ( as long as you are symptomatic while wearing them ), because even if they are normal they help to rule out other things which helps to determine POTS. 

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Thanks for the responses. :)

I know the cardiologist and the computer analysis won't be able to analyse the effects of posture and physical activity on heart rate changes, because they don't have data on my posture and physical activity. They don't have data on blood pressure, nor localised blood flow and oxygenation. They also don't have data on variables such as temperature, food and drinks consumed, noises or movements going on around me that could increase heart rate etc.

It should at least pick up a lot of bradycardia and tachycardia, as well as sudden rises and falls that might be identified as a bit abnormal. Tachycardia might be largely written off as potential physical activity during waking hours and as waking up during sleeping hours, and therefore too inconclusive to draw any firm conclusions. Bradycardia might stand out more as something that doesn't have such an easy 'normal' explanation, since my heart rate was probably in the 40s for extended periods during waking hours in the 24 hours that the monitor was on. Then again, unless it went below 40 for an extended period during waking hours (which it probably didn't), they might write it off as 'nothing to worry about for an athletic person' (even though I've only really been able to tolerate mild exercise over the past four years). I've just been using a blood pressure cuff to measure my heart rate at home so far, so it will be interesting to see what my heart rate does when I'm walking around and when I'm sleeping.

When I've had 10-second electrocardiograms done before, while lying down, the computer analysis typically gave notifications for maybe two or five features that doctors considered to be not worth investigating further. It'll be interesting to see what turns up from 24 hours that includes standing up and moving around.

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I did the 30 day holter, when the first cardiologist reviewed the results he stated it has having normal findings. When my cardiologist who knew of POTS saw some of the 'higher' readings he related it back to the variability of POTS rather than a stressful period at work or something like that. Overall my results were not extreme though; my heart rate although easily variable, doesn't typically have the extremes as some other POTS patients.

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I have had holter monitors more times than I can count, about 2 years ago they decided to put a chest port in for fluids and an implanted loop recorder (heart monitor) so that they had an accurate heart rate 24/7 really helps with my meds that control the tachycardia. Sometimes depending what is going on my heart rate gets to low bradycardia...loop recorder is awesome and doctors get to see what is happening without the bulky holter monitor. Helps with quality of life.

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  • 3 weeks later...

I picked up the report from the 24-hour Holter monitor today.

There's a lot of heart rate variability, ranging between 37 and 156 bpm, with 13 hours, 42 minutes and 44 seconds of bradycardia and 1 hour, 50 minutes and 16 seconds of tachycardia, according to the report. The most strenuous physical activity in the relevant 24 hour timeframe was walking to the bus stop or to and from the nearby shop to get a couple of small items.

Unsurprisingly, given my experiences with my state's health care system, the cardiologist's "interpretation" was just a summary of the computer-generated report, with no actual interpretation.

I found two obvious inconsistencies with data reported on the first page and data displayed in graphs and tables on subsequent pages. On top of that, a page of the report was missing, based on the page numbering, which goes from "Page 1 of 6" to "Page 3 of 6". There are also sections on the first page for QT Analysis and for ST Episode Analysis which have no data entered. Things I had discussed with both the receptionist(/nurse?) who put the Holter monitor on and the one who took it off were ignored or not communicated to the cardiologist.

The computer-generated report gives me some extra data, but the limited info provided in the printed report significantly reduces its usefulness. Given the two obvious inconsistencies I picked up, there could also be further errors, beyond just the limitations of the technology, that I don't have the necessary info to identify. This is yet another disappointing but not surprising experience with the health care system in my state (Tasmania, Australia). It's unclear whether the Holter monitor results will be enough to help upgrade my priority level for getting autonomic testing.

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  • 2 weeks later...

Hi, 

Ive worn so many holter monitors, I can’t even remember how many. They’ve all shown different things at different times, but they’ve all shown tachycardia (my latest one has show two forms of tachycardia), PVCs (in singles, trigeminy & quadrigeminy - over 20% of my heartbeats are PVCs) PACs, and bradycardia. 

I’ve had stress tests & echos. Heart is structurally sound, aside from mild mitral valve prolapse & mild tricuspid regurgitate

saw electrophysiologist, & he said it was all in my head & likely just anxiety. my heart rate was recorded several times going from 44 to 156. 

im grateful my heart is structurally sound but frustrated I haven’t been able to figure out why I feel this way or why my heart does this. 

I hope you’re able to receive further testing to help. 

shannon 

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On 3/24/2018 at 11:53 AM, Pistol said:

I had several holters - 24 hr, 48 hr, 30 days and then a implanted loop recorder that recorded EVERYTHING for 3 years until the battery ran out. The 24 hr one was the first one and actually recorded my very first syncopal episode: Sinus tachycardia in the 150's for 3 hrs. All the others showed tachycardia, PVC's (palpitations) and occasional atrial flutter ( not related to POTS ).  The monitors are very helpful even if they do not show anything ( as long as you are symptomatic while wearing them ), because even if they are normal they help to rule out other things which helps to determine POTS. 

When your battery ran out, did they take it out?, did they give you a new one?, what was it like having it dug out? Are you in the UK?

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When it ran out they removed it (both surgeries - inserting and removing - are simple and easily tolerable procedures), they did not give me a new one because the initial reason for it was to determine if my syncopal episodes and seizures were due to low HR so I might qualify for a pacermaker (they were not). I live in the US. I am a big supporter of ILR's ( inserted Loop Recorders ) because they record every heart beat, are easy to use ( you send the data by cell or land line to your ordering physician monthly or earlier if you have an event ) and the recordings show without a doubt what goes on with your heart rhythm every second of every day. In my case it confirmed the diagnosis of POTS and showed that I was not a candidate for a pacer. 

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  • 2 weeks later...

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