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A holter monitor is a portable electrocardiogram (ECG) that monitors cardiac activity for an extended period of time. Holter monitoring takes consistent records of heart rhythms for a 24-hour period while an individual goes about daily activity. This type of cardiovascular test allows patients to leave the doctor’s office while still participating in necessary long-term evaluations. 

A cardiologist attaches electrodes to places on the chest and stomach via gentle adhesive. The electrodes are wired to a portable ECG machine that records data. No electricity passes into the body but instead, the ECG picks up the natural electrical pulses created by the body and uses this information to display how fast the heart is beating and catches abnormal heart rhythms. 

A holter monitor is square-shaped and typically hangs around the neck on a comfortable lanyard or is attached to the waistband via a clip. The monitor weighs approximately one pound and is battery operated. In some cases, if a longer period of data gathering is needed, the cardiologist can set patients up with a wireless monitor. The process of holter monitoring is sometimes called an ambulatory electrocardiograph, a cardiac event monitor, or a 24-ECG. 

When is a holter monitoring test used? 

When gathering cardiovascular information including looking for abnormal heart rhythms, it’s standard procedure to conduct an electrocardiogram (often referred to as an ECG or EKG). This noninvasive test is performed at a doctor’s office and shows a snapshot of heart activity. The holter monitor takes this type of test one step further and tracks heart activity over a set amount of time to catch irregularities, like arrhythmias, that may not occur in the span of a doctor’s office visit. 

For individuals with existing heart problems or who are at higher risk of developing heart conditions, an extended test – such as an ambulatory electrocardiogram – can give cardiologists a better understanding of a patient’s heart condition. Both a holter monitoring test and an ECG/EKG prove vital in painting a clear picture of one’s heart health. 

A holter monitoring test may be ordered when a patient experiences the following conditions or needs specific evaluation: 

  • Arrhythmia or an irregular heartbeat
  • Unexplained fainting
  • Heart palpitations 
  • Heart disease
  • Tightness in the chest or upper back
  • Previously experienced a heart attack
  • Shortness of breath or becoming easily winded during minimal activity
  • To evaluate the effectiveness of a pacemaker 
  • To evaluate the risk for future heart related conditions like thickened heart walls (hypertrophic cardiomyopathy) 

How does holter monitoring work?

This noninvasive process involves the chest and abdomen. Depending on the person, the area may be shaved and cleaned prior to the test. Sticky electrodes are then attached and the cardiologist will show the patient how to wear the monitor and adjust it for a comfortable placement. 

The holter monitor needs to be worn at all times, even while sleeping, and cannot get wet so patients shouldn’t shower, bathe, or swim with it on. It’s important that the wearer records any symptoms that he or she feels. Certain holter monitors have buttons that the individual can use to timestamp said symptoms. Keeping a journal of symptoms like dizziness, arrhythmias, chest tightness and the like can help doctors get a clearer picture of the heart’s condition.

There are no risks associated with this test. The skin under the sticky electrodes may become itchy or irritated for those with sensitivities. Following your cardiologist’s instructions is important to the success of the test. Depending on the severity of your existing heart condition, you may be advised to wear the test for longer than 24 hours, with some tests being run over the span of many days. 

Avoid the following when receiving a holter monitoring test: 

  • Standing in close proximity to magnets
  • Smoking or using chewing tobacco or other products with nicotine
  • Extensive exercise unless advised by your doctor. This can lead to excessive sweating and cause the sticky pads to slip off. 
  • Certain electronics
  • Certain medications 

Interpreting results of a Holter Monitor Test

Once the test is finished, your doctor may ask you to return to the office or hospital to have the pads removed or provide instructions so you can remove them yourself. Upon returning the holter monitor and your journal to the doctor, he or she will assess the results and walk you through what the results mean. Your physician can use the results  to diagnose a heart condition or order additional testing. Additionally, the results may show the doctor how to alter your medication for improved health, give advice on lifestyle adjustments that can benefit your heart, or explore surgical options. 

Appointments and Next Steps

Speak with your cardiologist to determine if a holter monitoring test is needed. Individuals who have experienced a heart attack, heart disease or heart palpitations can benefit from a variety of cardiac testing to minimize damage or a second occurrence. Your cardiologist will know what’s best when it comes to evaluating your heart health and moving forward. 

UCF Health’s Orlando cardiologist has years of experience in diagnosing and treating all types of heart conditions. The heart is a most powerful muscle and vital to life. Taking care of yours through a healthy diet, routine checkups, and daily exercise can help mitigate many heart-related problems. 

Visit our patient portal for additional resources on how to maintain a healthy, active lifestyle and for COVID-19 updates for patients