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An ambulatory electrocardiogram (EKG or ECG) records the electrical activity of your heart while you do your usual activities. Ambulatory means that you are able to walk during the test. This type of monitoring may also be called ambulatory EKG, Holter monitoring, 24-hour EKG, or cardiac event monitoring.
Many heart problems are noticeable only during certain activities. These include exercise, eating, sex, stress, bowel movements, and even sleeping. An ambulatory electrocardiogram is more likely to find abnormal heartbeats that occur during these activities.
Many people have irregular heartbeats (arrhythmias) from time to time. What this means depends on the type of pattern they produce, how often they occur, how long they last, and whether they occur at the same time you have symptoms. Because arrhythmias can come and go, it may be hard to record one while you are in the doctor's office.
There are several different types of ambulatory monitors. Your doctor will choose the type that works best for you and is most likely to help diagnose your heart problem.
Ambulatory EKG monitoring is done to:
Your preparation may depend on the type of monitor you are getting.
Be sure to tell your doctor about all the medicines you take, even over-the-counter ones. Many medicines can change the results of this test.
If you are going to have electrode pads or a patch, take a shower or bath before the electrode pads are put on. You may not be able to get the pads wet during the test. Your doctor will give you instructions on how to wear the electrodes. Wear a loose blouse or shirt.
If you are getting a monitor under your skin, you will get instructions for how to prepare for the procedure.
Talk to your doctor if you have any concerns about the need for the test, its risks, how it will be done, or what the results will mean.
To help you understand the importance of this test, fill out the medical test information form ( What is a PDF document? ).
Your doctor will choose the type of heart monitor that is most likely to help diagnose your heart problem. You may have a monitor that records your heart activity all of the time or only some of the time.
Continuous recorders are a common type of monitor used for this test.
A Holter monitor gives a 24- to 48-hour record of the electrical signals from your heart. Wireless patch monitors can be used for many days. A standard EKG monitors only 40 to 50 heartbeats during the brief time you are attached to the machine. A continuous recorder monitors about 100,000 heartbeats in 24 hours. It is likely to find any heart problems that happen with activity.
You will see a doctor or technician to get your heart monitor and to learn how to use it.
Event monitors are used when symptoms of an abnormal heart rhythm do not happen very often. This kind of recorder can be used for a longer time than a continuous recorder. The information collected by an event monitor can often be sent over the phone or online to a doctor's office, clinic, or hospital.
You may be told to call your doctor, clinic, or hospital while you are having symptoms or soon after you record your heart rhythm. This way the information on the monitor can be looked at right away.
There are different types of monitors.
Your doctor will explain the details of how to use your monitor. If you have to do anything to send your heart data, your doctor will show you how.
What you do during the test
Your doctor may ask you to keep a diary of all of your activities and symptoms while you wear the monitor. You will write down the type of activity you were doing and the time your symptoms started. For example, write down the exact times when you:
If you have any symptoms of heart problems, such as dizziness, fainting, chest pain, or abnormal heartbeats, push the event-marker button on the recorder to mark it (if you have the type that allows you to). Then write down the exact time and how long the symptom lasts. For example, you might write: "12:30 p.m. Ate lunch. 1:00 p.m. Argument with boss, had chest tightness for several minutes."
If one of the electrodes or lead wires comes loose, a light on the monitor will flash. Press on the center of each electrode to see if you can restore the contact. Call your doctor if one of the electrodes comes off and you can't get it to stay on.
Your doctor will tell you if you need to stay away from strong electromagnetic fields while wearing a monitor. These may include magnets, microwave ovens, and electric blankets. Signals from these types of electronic equipment can sometimes affect the recording.
What you and your doctor do after the test
At the end of the recording period, your doctor will give you instructions. If you had electrode pads or a patch, you may go to the doctor's office or hospital to have them removed. Or you may be able to remove them yourself. Your doctor will let you know how to return the monitor.
Your doctor will review the data from your monitor and also look at your records of activities and symptoms and times they occurred. Your doctor will compare the timing of your activities and symptoms with the recorded heart pattern.
If you have electrodes or pads on your skin, those places may itch slightly during the test. The skin on your chest may look or feel irritated when the electrodes are removed.
Heart monitors are typically very lightweight. So carrying or wearing them is usually is not uncomfortable.
For an implantable heart monitor, you will get medicine to numb the area of your chest where the monitor will be put in. You will be awake when the doctor makes a small cut and places the monitor under the skin. You shouldn't feel any pain.
There is no risk from ambulatory EKG monitoring. The electrodes placed on your skin detect only the electrical signals from your heart. No electricity is sent through your body. So there is no chance of getting an electric shock.
An ambulatory electrocardiogram (EKG or ECG) is a test that records the electrical signals that control your heartbeat while you do your normal activities.
Results of ambulatory EKG monitoring usually are looked at by a cardiologist or cardiac electrophysiologist. The results are most often available in a few days.
No abnormal heart rhythms are found. Your heart rate may go up when you are active and go down when you are sleeping.
Many kinds of abnormal heartbeats can be found by ambulatory monitoring.
The results of this test are compared with your medical history, symptoms, and other test results. Your doctor will also compare the results with your diary of activities and symptoms. You may need to have the test again if the results aren't clear.
The test results may not be accurate or helpful if:
Ambulatory heart monitoring works best when you carefully follow instructions while you're being monitored.
Fischbach F, Dunning MB III (2015). A Manual of Laboratory and Diagnostic Tests, 9th ed. Philadelphia: Wolters Kluwer Health.
Other Works Consulted
Chernecky CC, Berger BJ (2013). Laboratory Tests and Diagnostic Procedures, 6th ed. St. Louis: Saunders. Fischbach F, Dunning MB III (2015). A Manual of Laboratory and Diagnostic Tests, 9th ed. Philadelphia: Wolters Kluwer Health. Pagana KD, Pagana TJ (2014). Mosby's Manual of Diagnostic and Laboratory Tests, 5th ed. St. Louis: Mosby. Shen W-K, et al. (2017). 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope. Circulation, published online March 9, 2017. DOI: 10.1161/CIR.0000000000000499. Accessed March 30, 2017.
ByHealthwise Staff Primary Medical Reviewer Rakesh K. Pai, MD - Cardiology, Electrophysiology E. Gregory Thompson, MD - Internal Medicine Martin J. Gabica, MD - Family Medicine Elizabeth T. Russo, MD - Internal Medicine Adam Husney, MD - Family Medicine George J. Philippides, MD, FACC - Cardiology
Current as ofDecember 6, 2017
Current as of:
December 6, 2017
Rakesh K. Pai, MD - Cardiology, Electrophysiology & E. Gregory Thompson, MD - Internal Medicine & Martin J. Gabica, MD - Family Medicine & Elizabeth T. Russo, MD - Internal Medicine & Adam Husney, MD - Family Medicine & George J. Philippides, MD, FACC - Cardiology
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