Holter monitor

[WolfmanHarris]

So I'm wearing a holter monitor for the next 48 hours as my family physician tries to figure out why I had a seizure at the end of August (which he thinks might have been syncope, hence the holter and echocardiogram). Anyways I tried to engage the holter tech a bit and learn about the procedure and she either didn't understand my questions or didn't feel like answering them because I didn't learn a thing.

So who here knows a bit about the Holter? It's got seven wires. I think it's monitoring lead II and V5, V6 based on where some of the daisies are, but I'm not sure about the others. Any thoughts?

Thanks,

- Matt

[crotchitymedic1986]

Depends on the type of monitor you are wearing. I worked part-time for cardionet for about a year, but us techs just interpreted the final product. The new monitors that were coming in as I left (I think called Rosin monitors or systems) interpreted the rhythms, we just had to go back and see what was real versus artifact, we then chose the best strip of the hour, and created a 24-48 hour report that was sent back to the doctor. If any critical events were noted, we had to notify the doctor right away, which caused alot of friction, as doctors got pissed when you woke them up at 3am to let them know their 88 year old patient had a 4 second run of vtach (you would be amazed how many patients have episodes of vtach, sinus arrest, and heart block (especially during sleeping hours).

But usually, the patients in your case showed nothing (younger, single episode seizure/syncope patients). Make sure your diary is legible, if you are keeping one --- its daunting to read your diary after it has been faxed two or three times.

[crotchitymedic1986]

Sorry, the typical event monitors were 3 lead -- the new Rosin were continuous 12 Lead, which is why everyone was starting to use them, but it was new technology, and all the bugs were not worked out of the program before it was used in the field --- lots of blank scans, artifact scans, more possibility of getting a totally useless scan, whereas the old model was fairly reliable as long as the leads stayed on.

[akroeze]

I had to wear one too (periods of chest pain).

My biggest suggestion is that if you get the chance to get copies of your strips and 12-leads don't! You'll over analyze things to the point of obsession. Things you'd brush off as nothing for one of your patients will seem like the end of the world on yours. At least that was my experience

But at the same time, do get copies.... you want them for your own records. It is always good to have an old ECG to compare to just in case.

So I guess what I'm saying is DO get copies and DON'T look at them

[WolfmanHarris]

I don't think it's a standard 12 lead. The leads are placed in the following areas:

1)R midclavicular 1st intercostal space

2) R midclavicular 3rd intercostal space

3) Sternum 2nd intercostal

4) L midclavicular 1st intercostal space

5-7) in a line L axillary 6th intercostal

And I already that mistake when we started studying 12-leads. The monitor described mine as unconfirmed abnormal and mentioned something about the QRS. I couldn't see a thing and carried it in my back pocket to the cardiology clinic. Unfortunately (or fortunately as I forgot about it) the echocardiogram tech wasn't trained in ECG's so I had no one to go through it with. My instructor couldn't see anything out of the ordinary either.

I might be off on the space, I learned 12 lead literally 2 weeks ago and am still getting the hang of the anatomical markers with all that pesky skin, muscle and adipose in the way.

[crotchitymedic1986]

Since the topic has been brought up, for all BABY medics out there, if you ever need strips for school, buddy up with someone who works for cardionet (Cardionet and PDS heart merged). You can get really good strips of blocks, vtach, vfib, pacemaker rhythms, WPW, and any other weird rhythm on a daily basis. I know that they had offices in Georgia, Florida, and California -- i am sure there are many more. Most the people working there are part-time medics who are happy to fax you a good strip.

[crotchitymedic1986]

each doctor or cardiologist chose the leads (by electrode placement), and it differed from doc to doc. The 3 lead was usually white. The new rosins were black and had a touch screen for you to hit your "events", whereas the 3 lead just had a generic "event" button that you hit for everything, and then you described the "event" in your diary.

[akroeze]

When I had mine I wasn't told to mark any events. I simply wore it then returned it to the doc who downloaded it on his computer and he had a crapload of strips.

[VentMedic]

Medical professionals such as Echo, RRT or CV Technologists are NOT going to discuss much more than to give you the necessary information to get through the test or the required teaching for special procedures. Many will down play what they know just to avoid questioning from a patient about a cause.

If the technologists know you are in the medical profession but are asking questions that indicate you know some but not a lot, they will be extremely cautious as to what they say to you. Too many will read too much into something.

Those that work in the hospitals know that it may take many tests for a definitive diagnosis unlike EMS where an emergent situation arises and you may treat a "symptom" or one manifestation from a disease process but don't actually know the true diagnosis or cause for that symptom to appear. There may be speculation but that is about all.

Various nondescript EKGs changes on a young person can be anything from a serious disorder to poorly positioned electrodes.

If I am working in a cardiac or pulmonary lab I will say as little as possible and attempt not to make any expressions if I do pick up on something. People will want to know:

Do I have lung cancer? How bad is my heart damage? What's wrong with me? The questions from the transplant candidate screenings are the toughest because they know if denied as the result of a test, they're probably going to be dead fairly soon.

Since it is usually not an immediate emergency situation happening during the testing and knowing that some diagnostics are just one small part of the puzzle, I tell patients to wait until the doctor has had a chance to analyze ALL tests (and shut the h*&$ up so I can finish your test).

[WolfmanHarris]

Hmm... not the way I'd like to do things, but I don't work these jobs so I don't know. I wasn't grilling her by any means, just asked which leads it was monitoring in. I got the message and didn't bother pushing the issue, hence I'm asking if anyone else has input on what exactly the monitor is watching. Pure curiosity.

I've read my texts including my ECG book and none of them deal with any monitoring beyond Lead II or standard 12 lead. So I'm not familiar with what angles of the heart this monitor's looking at.