Ambulatory Cardiac Monitoring

Overview

Standard EKGs only capture 10 seconds of heart activity. Ambulatory monitors record activity over 24+ hours to capture intermittent symptoms (palpitations, syncope) occurring in daily life.

1. The Holter Monitor (Continuous)

• Duration: 24 to 48 hours.
• Type: Continuous recording.
• Patient Instructions (High Yield):
  • Keep it Dry: No showering, swimming, or bathing. Sponge bath only.
  • The Diary: Patient MUST keep a diary of activities and symptoms. Press the Event Marker button when symptoms occur.
  • Normal Routine: Do not avoid stress/exercise; the doctor wants to see the heart under normal conditions.
  • Avoid Interference: No electric blankets or magnets.

2. The Event Monitor (Intermittent)

• Duration: Up to 30 days.
• Type: Patient-Activated.
• Use: For infrequent symptoms that might not happen in a 24-hour window.
• Mechanism: The patient presses a button when they feel a symptom to save the recording.

Comparison:

• Holter = Continuous, Short Term (Daily symptoms).
• Event = Patient-Triggered, Long Term (Sporadic symptoms).

3. Exercise Stress Test

• Purpose: Evaluates heart function under physical stress (treadmill/bike).
• MA Role:
  • Safety: Monitor the patient for distress (chest pain, fatigue).
  • Vitals: Periodically check and record Blood Pressure and Heart Rate during each stage of exercise.
  • Protocol: Stop immediately if the patient has chest pain or cardiac distress.