Holter ECG: How It Is Worn, What It Shows and What It Costs
A Holter ECG records the work of the heart over 24 hours or longer while you do what you normally do: go to work, walk, sleep. It is ordered when someone feels palpitations, skipped beats, a fast or irregular heartbeat, dizziness or fainting, because an ordinary ECG in the consulting room lasts a few seconds and rarely catches a symptom that comes and goes. This article explains how a Holter is worn, what you may and may not do while wearing it, what the report shows and when extra beats and a fast pulse are a reason for an appointment.
When a Holter ECG is done
- palpitations, a feeling of skipped beats or a “thump” in the chest that comes and goes;
- attacks of a fast heartbeat that start and stop abruptly;
- dizziness, loss of consciousness or a feeling that you are about to faint, with no clear cause;
- following a known rhythm disorder and judging whether the treatment is working;
- assessing the rhythm in disease of the heart muscle or after a cardiac event, when the cardiologist decides it is needed.
How a Holter is worn
Several electrodes are stuck onto the cleaned skin of the chest, and a small recorder is worn on the belt or around the neck. The recording usually lasts 24 hours, and for symptoms that occur less often the doctor may set a longer recording. Fitting it takes a few minutes and is not painful.
- Do not get the recorder or the electrodes wet: no showering or bathing while the recording lasts. Shower before it is fitted.
- Live an ordinary day: work, a walk, the stairs. The point is to record the heart in real conditions, not at rest.
- Keep a diary: write down the time of any symptoms (palpitations, dizziness, pain) and what you were doing, as well as the times you slept and exerted yourself. Without a diary the recording is harder to interpret.
- Do not pull the cables and do not remove the electrodes. If one comes loose, press it back and write down the time.
- Avoid electric blankets and magnetic mats, and do not keep your phone pressed against the recorder.
What a Holter report shows
| Item in the report | What it means |
|---|---|
| Heart rate | The average, lowest and highest pulse through the day and the night. At night the pulse naturally falls, in young people and athletes even below 50 a minute. |
| Supraventricular extrasystoles (SVES) | Premature beats that start in the atria. Isolated ones are found in completely healthy people too. |
| Ventricular extrasystoles (VES) | Premature beats that start in the ventricles. Their significance depends on the number, the shape, whether they come in runs and whether the heart is structurally healthy. |
| Episodes of tachycardia | Periods of a fast heartbeat. What matters is whether they coincide with the symptoms written in the diary. |
| Atrial fibrillation | A completely irregular, often fast heartbeat. A finding that calls for a cardiology appointment and a treatment plan. |
| Pauses and a slow heartbeat | Periods with no beats or a very slow pulse. Longer pauses, especially with dizziness or fainting, need prompt assessment. |
Extra beats: when they are harmless
Almost everyone has the occasional extra beat over 24 hours, and in many healthy people a Holter records several hundred of them with no significance at all. They are felt as a skipped beat, a short pause or a stronger beat after it. They are made worse by coffee, energy drinks, alcohol, lack of sleep, stress, dehydration and an overactive thyroid.
Attention is needed for extra beats that make up a large share of all beats (roughly more than ten percent), that come in runs, or that come with breathlessness, chest pain or fainting. The cardiologist then usually also orders an ultrasound of the heart, to check that the heart muscle is healthy, and tests such as electrolytes and thyroid hormones.
A fast heartbeat and tachycardia
A resting pulse in adults is usually between 60 and 100 beats a minute. A fast heartbeat is normal with exertion, excitement, fever and in pregnancy. A reason for an appointment is a resting pulse that is constantly above 100, attacks of palpitations that start and stop abruptly, an irregular pulse, and a fast heartbeat with breathlessness, chest pain or dizziness. Among the causes a doctor checks are anemia, an overactive thyroid, dehydration, stimulants and rhythm disorders.
When not to wait for a Holter
A Holter is an examination for symptoms that come and go. If the symptom is happening now, call emergency services (194): pain or tightness in the chest, loss of consciousness, severe difficulty breathing, palpitations with fainting, or a fast heartbeat that will not stop along with marked weakness.
What an appointment at Miren Medic looks like
A cardiology appointment at the Miren Medic clinic begins with a conversation about your symptoms and risk factors, a blood pressure measurement and an ECG. Appointments are held by Prof. Dr Radoslav Romanović, internist cardiologist and interventional cardiologist, Dr Saša Ivanović, subspecialist in cardiology, and Dr Mila Živojinović, cardiologist. The ultrasound of the heart, the Holter ECG and the blood pressure Holter are done at the clinic, and blood tests in the clinic laboratory, so the whole work-up finishes in one place. All of it without a referral.
Prices
| Service | Price |
|---|---|
| Holter ECG | 7.000 RSD |
| Holter TA (blood pressure) | 6.000 RSD |
| Ultrasound of the heart | 8.000 RSD |
| Cardiology appointment (Dr Mila Živojinović) | 6.000 RSD |
| Cardiology appointment + ultrasound of the heart (Dr Mila Živojinović) | 12.000 RSD |
| Cardiology appointment (Prof. Radoslav Romanović) | 10.000 RSD |
| Cardiology appointment + ultrasound of the heart (Prof. Radoslav Romanović) | 14.000 RSD |
Frequently asked questions
How is a Holter ECG worn?
Electrodes are stuck to the chest and you wear the recorder on your belt or around your neck, usually for 24 hours. During the recording you live an ordinary day and keep a diary of symptoms and activities, and afterwards you return the recorder so the trace can be analyzed.
May I shower while wearing a Holter?
No. The recorder and the electrodes must not get wet, so showering is left for before the device is fitted and after it is removed.
How many extra beats are normal on a Holter?
Most healthy people have isolated extra beats, often several hundred over 24 hours. Their significance grows when there are many of them, when they come in runs or alongside symptoms and heart disease, and that is assessed by a cardiologist together with an ultrasound of the heart.
Can a Holter ECG be done in pregnancy?
It can. The recording uses no radiation and is safe in pregnancy. A fast pulse is common in pregnancy, but palpitations with breathlessness, chest pain or fainting call for an appointment.
What if I had no symptoms while wearing the Holter?
A normal trace over a day without symptoms does not rule out a rhythm disorder that occurs rarely. The doctor may then suggest repeating the recording or making it longer, depending on how often the symptoms occur.
When is a fast heartbeat dangerous?
When the resting pulse is constantly above 100, when the heartbeat is irregular, and especially when palpitations come with chest pain, breathlessness, dizziness or loss of consciousness. With those signs call emergency services, and check occasional attacks without them through an appointment and a Holter.
Book an appointment
If you feel palpitations or skipped beats, book a cardiology appointment at the Miren Medic clinic. The appointment with an ECG, the ultrasound of the heart and the Holter come from one place, without a referral.
