What does a 24-hour Holter Monitor detect? | Cardiology

What is a holter monitor?

The Holter monitor is a small, battery-powered medical device that measures your heart’s activity, such as rate and rhythm. Your doctor may ask you to use one if they need more information about how your heart is working than a routine electrocardiogram (EKG) can provide.

A 24-hour Holter monitor is a continuous test to record your heart rate and rhythm for 24 hours. You wear a Holter monitor for 12 to 48 hours while going about your regular daily routine. This device has electrodes and electrical wires just like a regular EKG, but it has fewer leads. It can detect not only your heart rate and rhythm but also when you feel chest pain or symptoms of an irregular heartbeat or an irregular heartbeat.

The Holter monitor test is sometimes called a mobile ECG. There are different kinds of gadgets that can be utilized to gauge heart movement for longer time frames.

Why holter monitor?

In the event that you have signs or manifestations of a heart issue, for example, an unpredictable heartbeat (arrhythmia) or unexplained blacking out, your PCP may arrange a test called an electrocardiogram. An EKG is a short, non-invasive test that uses electrodes attached to your chest to check your heart’s rhythm.

However, sometimes, the EKG doesn’t detect any abnormalities in your heart rhythm because you are only connected to the device for a short time. If your signs and symptoms indicate that an irregular heartbeat may be causing your condition, your doctor may recommend that you wear a Holter monitor for a day or so. Over this time, the Holter monitor may be able to detect an irregularity in your heart rhythm that the EKG cannot detect.

Your doctor may also order a Holter monitor if you have a heart condition that increases your risk of developing an abnormal heart rhythm. Your doctor may suggest wearing a Holter monitor for a day or two, even if you don’t have any symptoms of an abnormal heartbeat.

How would I prepare for a holter monitor?

  • Your health care provider will explain the procedure and you can ask questions.
  • You do not need to fast (neither eat nor drink).
  • Depending on your medical condition, your healthcare provider may require another specific preparation.

What happens during a holter monitor?

Holter monitor is generally recorded on an outpatient basis. Procedures may vary depending on your condition and the practice of your healthcare provider.

In general, Holter screen recording follows this process:

  • You will be asked to remove any jewelry or other items that may interfere with the reading.
  • You will be asked to undress from the waist up so that the electrodes can be attached to your chest. The technician will ensure your privacy by covering you with a sheet or gown and only exposing the necessary skin.
  • The areas where the electrode stains are placed are cleaned, and in some cases, the hair may be shaved or trimmed so that the electrodes are closely attached to the skin.
  • Electrodes will be attached to your chest and abdomen. The Holter monitor will be connected to the electrodes by wires. The small screen box may be worn over your shoulder like a shoulder bag or around your waist or it may be attached to a belt or pocket.
  • Find out if you will have to change the batteries in the display. Make sure you know how to do this and that you have extra batteries on hand.
  • Once you are connected to the monitor and given instructions, you can return to your usual activities, such as work, housework, and exercise, unless your health care provider tells you otherwise. This will allow your healthcare provider to identify issues that may only occur with certain activities.
  • You will be asked to keep a diary of your activities while wearing the screen. Write down the date and time of your activities, especially if any symptoms, such as dizziness, heart palpitations, chest pain, or other previously encountered symptoms, occurred.

After the procedure

Once your observation period is over, you will return the device to your doctor’s office, along with the notes you kept while wearing a Holter monitor. Your doctor will compare data from the recorder and the activities and symptoms you noted.

What are the risks of a Holter monitor?

The Holter monitor is an easy way to assess heart function. The risks associated with a Holter monitor are rare. It can be difficult to keep the electrodes attached to your skin, and you may need extra tape. It can be uncomfortable when removing sticky electrodes and tape. If the electrodes are run for a long time, they may cause tissue breakdown or skin irritation at the application site. There might be different dangers relying upon your particular ailment. Make certain to talk about any worries with your medical care supplier before wearing the screen.

Certain factors or circumstances may interfere or affect the results of a Holter monitor. These include, but are not limited to:

  • Near magnets, metal detectors, high-voltage electrical wires, and electrical appliances such as razors, toothbrushes, and microwave ovens. Cell phones and MP3 players can also interfere with signals and they should be at least 6 inches away from the display box.
  • Smoking or using other forms of tobacco
  • Certain medications
  • Excessive sweating, which may cause the strings to loosen or fall off

Understanding the results

After the test period, the person returns to their doctor to have the screen removed. Provide any notes for the doctor to review and the doctor will consider screen readings and the person’s notes when making a diagnosis.

Holter monitor readings may reveal an underlying heart condition, new symptoms, and potential triggers. It may also help show the problems caused by medications. A person may have to wait for one to two weeks for the test results.


Types and Procedures of Echocardiogram (Echo) | Cardiology

What is an echocardiogram?

An echocardiogram (echo) is a graphic diagram of a heartbeat. During the echo test, ultrasound (high-frequency sound waves) from a handheld rod placed on your chest provides images of the heart valves and chambers and helps the sonographer assess the pumping activity of the heart. Echo is often combined with doppler ultrasound and colour doppler to assess blood flow in the heart valves.

Different types of echocardiogram

● Transthoracic echocardiogram

  • Transesophageal echocardiogram
  • Doppler echocardiogram

● Stress echocardiogram

Transthoracic echocardiogram

On this standard type of echocardiogram:

  • The transducer records the echo of the sound wave from your heart.
  • The computer converts the echoes into moving pictures on the monitor.
  • A technician (sonographer) spreads the gel on a device (transducer).
  • The sonographer presses the transducer against your skin and pushes the ultrasound beam through your chest to your heart.

If your lungs or ribs are blocking your vision, you may need to inject a small amount of the augmentation agent intravenously (IV). The enhancing agent, which is generally safe and well-tolerated, will make the structures of your heart more clearly visible on the monitor.

Transesophageal echocardiogram

 For this test, the transducer goes down your throat and into your esophagus (the swallowing tube that connects your mouth to your stomach). Because it’s closer to your heart, it can get a clearer picture. Do not eat or drink anything until 6 hours before the test. Take all of your medicines at regular intervals, with a sip of water if necessary. If you are using medicines or insulin for diabetes, ask your doctor or testing centre about this.

Before a transesophageal echocardiogram, a nurse places an intravenous line into a vein in your arm or arm to give you medicine. A technician will place EKG electrodes on your chest. They also place a blood pressure monitor in your hand and a pulse oximeter clamp on your finger to check your vital signs.

Doppler echocardiogram

In addition to sound waves bouncing the visual structures of the heart, they also bounce red blood cells as they pass through the heart chambers. Using Doppler technology, an echocardiogram can estimate the speed and direction of blood flow, which can help increase the amount and quality of information available from the test.

Computer colour can be added to compliment the doctor on that information. Colour flow Doppler is routinely added to all echocardiography studies and is the same technique used for weather reports.

Stress echocardiogram

A doctor may order an echocardiogram as part of a stress test. Stress tests involve physical exercise, such as walking or jogging on a treadmill. During the test, the doctor monitors the heart rate, blood pressure, and electrical activity of the heart. A sonographer performs a transthoracic echocardiogram before and after exercise.

  • Heart failure
  • Coronary heart disease
  • Ischemic heart disease
  • Problems affecting the heart valves heart

What is the use of an echocardiogram?

The echocardiogram test is used for:

  • To determine the presence of a variety of heart diseases such as valve disease, myocardial disease, pericardial disease, infective endocarditis, heart mass, and congenital heart disease.
  • Follow the progression of valve disease over time
  • Evaluate the effectiveness of your medical or surgical treatments
  • Assess the overall function of your heart

What happens during the echo?

Echocardiogram tests are performed by specially trained technicians. Your exam may take place in your doctor’s office, emergency room, operating room, hospital clinic, or hospital room. The test lasts about an hour.

  • The probe (transducer) is sent to your chest. The probe produces sound waves that bounce your heart and “resonate” again through the probe.
  • You lie down on a table and a technician places small metal discs (electrodes) on your chest. The discs contain threads that hold the hook to the electrocardiograph. An electrocardiogram (ECG or ECG) tracks your heart rate during your test.
  • Your technician will place a gel on your chest to allow sound waves to pass through your skin. The probe (transducer) is passed across your chest. The probe produces sound waves that bounce off your heart and “echo” back to the probe.
  • The room is dark so your technician can see the video monitor well.

What are the risks of an echo?

This echocardiogram procedure is harmless and involves minimal risk. You may feel uncomfortable with the position of the transducer as it puts pressure on the surface of the body. For some, lying on the test table for the entire duration of the echo procedure can cause discomfort or pain.

You may have other risks depending on your specific health condition. Discuss any problems with your doctor before the procedure.


There are no known dangers of external TTE testing. TEE is an aggressive process. There is some risk associated with the test. These may include:

  • Reaction to narcotics.
  • Damage to the esophagus. This is very common if you already have a problem with your esophagus.

Overview of lumbar puncture (spinal tap) | Neurology

What is a lumbar puncture (spinal tap)?

A lumbar puncture (spinal tap) is acted in the lower back, in the lumbar locale. During a lumbar puncture, a needle is inserted between the two lumbar bones (vertebrae) to remove a sample of cerebrospinal fluid. This is the liquid that encompasses the cerebrum and spinal rope to shield them from injury.

A lumbar puncture can help analyze genuine contaminations, for example, meningitis. Other central nervous system disorders, such as Guillain-Barré syndrome and multiple sclerosis, or cancers of the brain or spinal cord. A lumbar puncture is now and again used to infuse sedation or chemotherapy drugs into the cerebrospinal liquid.

Why is a spinal tap performed?

A spinal tap may be performed to rule out an infection such as meningitis or encephalitis as a cause of epileptic seizures.

Besides used to treat epilepsy, the cerebrospinal fluid test can help diagnose disorders of chronic inflammatory demyelinating polyneuropathy, the central nervous system that may include the brain, spinal cord, or their covering (the meninges). Examples include meningitis, multiple sclerosis, Guillain-Barré syndrome, or idiopathic headache.

CSF contains glucose (sugar), proteins, and different substances found in the blood. The fluid test will show the number and types of white blood cells, glucose level, types and levels of proteins, and the presence of bacteria, fungi, or abnormal cells.

A spinal tap may also be performed:

  • Measurement of pressure around the brain and spinal cord
  • Relieve pressure in the head
  • Spinal anaesthesia
  • Inject the dye for an X-ray diagnostic test
  • Injection medications (such as baclofen)

NOTE: A cerebrospinal fluid test may not be necessary if a spinal tap is done to inject the drug.

What are the benefits of a lumbar puncture?

A lumbar puncture can help your PCP precisely analyze or preclude certain ailments, including some dangerous ailments. The sooner they diagnose the diagnosis, the faster you can get appropriate treatment. Some conditions, such as bacterial meningitis, can be fatal if you don’t get them treated quickly enough.

A lumbar puncture can likewise enable your PCP to give you a few sorts of prescriptions.

What are the risks of a lumbar puncture?

A lumbar puncture is generally safe, but there may be some risks. According to our clinic, up to a quarter of people who have a lumbar puncture develop a headache afterwards. Lying down for a few hours after the procedure may reduce your risk of headaches.

Other potential risks include pain or pain in the lower back and bleeding near the puncture site. You may feel some pain and numbness going down your legs. In rare cases, people have brainstem herniation, which is the movement of brain tissue from its normal position in your skull. This is uncommon.

Before having a lumbar puncture

Your primary care physician or medical caretaker ought to clarify what will occur and why you need a lumbar puncture.

A few days or weeks before the test:

  • You may have a CT scan or an MRI scan – to make sure you need a lumbar puncture and that it is safe to have one.
  • Tell the hospital if you are taking blood-thinning medications (anticoagulants) – such as warfarin

On the day:

  • You can eat, drink and accept prescription as would be expected
  • You will be drawn closer to sign a consent structure
  • You will usually need to undress and wear a hospital gown before the procedure – you may also want to use the toilet

How is the LP procedure performed?

Usually, patients lie on their side for the procedure. Often times, the procedure is performed while the patient is seated and leaning slightly forward.

After nearby sedation is infused into the lumbar district, a long needle is embedded between the bones of the spine (vertebrae) into the spinal waterway. (The needle is most usually positioned between the third and fourth lumbar vertebrae.)

Your cerebrospinal fluid pressure may then be measured and the cerebrospinal fluid (CSF) removed for testing.

What happens after a lumbar puncture?

This helps reduce the occurrence of headaches. It will allow you to roll from side to side as long as your head is not raised. If you need to urinate, you may need to do so in a bedspread or urinal during the time you need to stay flat.

You will be asked to drink additional fluids to replace the fluids after the operation. This replaces the cerebrospinal fluid that was withdrawn during a spinal tap and reduces the chance of a headache. After you recover, you may be taken to your hospital room or discharged home. If you go home, your healthcare provider will usually advise you to rest for the rest of the day

Once you are at home, notify your service provider of any abnormalities, such as:

  • Numbness and tingling in the legs
  • Blood or pain at the injection site
  • Inability to urinate
  • Headache

In the event that the migraine endures for in excess of a couple of hours after the technique, or when the position changes, contact the Neuroradiology group with the telephone number on your release directions.

You may be required to restrict your activity for 24 hours after the procedure. Your healthcare provider may give you other specific instructions about what to do after the lumbar puncture.

Spinal tap results

The CSF samples are sent to a laboratory for analysis. Lab technicians check a number of things when examining spinal fluid, including:

  • General look: The cerebrospinal fluid is usually clear and colourless. If it is cloudy, yellow, or pink, this may indicate abnormal bleeding. Green spinal fluid may indicate an infection or the presence of bilirubin.
  • Protein (total protein and presence of certain proteins): High levels of total protein – more than 45 milligrams per deciliter (mg / dL) – may indicate the presence of an infection or other inflammatory conditions. The specific laboratory qualities may fluctuate from the clinical office to the clinical office.
  • White blood cells: The cerebrospinal fluid usually contains up to 5 white blood cells (mononuclear leukocytes) per microliter. Increasing numbers may indicate infection. Specific laboratory qualities may differ from the clinical office to the clinical office.
  • Sugar (glucose): A low level of glucose in your cerebrospinal fluid may indicate an infection or other condition.
  • The presence of microscopic organisms, infections, parasites, or different microorganisms can show disease.
  • Cancer cells: Abnormal cells in the cerebrospinal fluid – such as a tumor or immature blood cells – can indicate certain types of cancer.

Lab results are combined with information obtained during the test, such as cerebrospinal fluid pressure, to help determine a possible diagnosis. A healthcare professional generally gives you results in a few days, but it may take longer. Ask when you expect to receive your test results.


Polysomnography (Sleep Study) Procedure | Neurology

What is Polysomnography?

Polysomnography, also called a sleep study, is a test used to diagnose sleep disorders. Polysomnography records cerebrum waves, blood oxygen level, pulse, and breathing, just as eye and leg developments during the examination.

Polysomnography is usually done in a sleep disorders unit within a hospital or a sleep centre. The test records your sleep patterns at night. Polysomnography is sometimes performed during the day to accommodate the shift workers who usually sleep during the day.

In addition to helping diagnose sleep disorders, polysomnography can be used to help adjust your treatment plan if you have already been diagnosed with a sleep disorder.

Why do I need a polysomnography?

A doctor can use polysomnography to diagnose sleep disorders. The symptoms of sleep apnea, which is a disorder in which breathing constantly stops and starts again, is often evaluated during sleep. Symptoms include sleep apnea:

  • Daytime sleepiness despite rest
  • Constant and loud snoring
  • Periods of holding your breath during sleep, followed by inhalations for air
  • Frequent bouts of awakening during the night
  • Sleep without rest

Polysomnography can likewise enable your PCP to analyze the accompanying rest issues:

  • Sleep-related seizure disorders
  • Periodic limb movement disorder or restless legs syndrome, which involves uncontrolled bending and extending of the legs during sleep
  • REM sleep behaviour disorder, which involves the realization of dreams during sleep
  • Chronic insomnia, which involves difficulty falling asleep or staying asleep

The National Heart, Lung, and Blood Institute (NHLBI) warns that if sleep disorders are not treated, they may increase your risk:

  • Heart disease
  • Stroke
  • High blood pressure
  • Depression

There is also an association between sleep disturbances and an increased risk of injuries associated with falls and car accidents.

How do you prepare for the sleep study?

You may be advised to avoid drinks or foods containing alcohol or caffeine during the afternoon and evening hours before polysomnography. Liquor and caffeine can adjust your rest examples, and they may intensify indications of some rest problems.

A nap in the afternoon before a sleep study is discouraged. You will usually be asked to shower or shower before your sleep study. However, do not apply lotions, gels, cologne, or make-up before the test, as they can interfere with the use of the electrodes.

Polysomnography procedure

People usually arrive at a sleep centre in the evening to stay overnight to monitor their sleep patterns.

The environment is usually set up in a style similar to a hotel room, with a private bathroom and little noise or light to distract the individual. The room is equipped with a video camera to capture the movement and behaviour of the individual during his sleep, in addition to an audio system that allows any sounds to be monitored. This also allows for communication with technicians, if needed, for example, if the patient needs to go to the bathroom at night.

After the individual is ready to sleep according to their nighttime routine, a sensor will be placed on the scalp, temples, chest, and legs. The sensors are associated with the registering framework, through long wires that permit the person to move unreservedly in the bed. A blood oxygen level monitor is also placed on the patient’s finger or ear to monitor changes.

It’s normal to have a harder time falling asleep more than usual in an unfamiliar environment, but this will not affect the results as each stage of sleep will eventually arrive, even if bedtime is longer.

Depending on the purpose of polysomnography, there may be other specific machines involved in the study. For example, a positive airway pressure (PAP) machine can help improve breathing for individuals with sleep apnea. In the morning, the sensors are removed and the individual can leave the sleep centre and continue normal daily activities immediately.

Are there any risks?

Polysomnography usually does not carry any risks.

Nonetheless, now and again, an individual may respond to the cement that connects the sensors to their body. If they are concerned about this, they should talk to the technician beforehand.

What do the results of a polysomnogram mean?

One of your roles as a sleep technologist is to record sleep stages and recorded events and plan them for your doctor’s review. Your observations during the study are crucial in helping the sleep doctor identify specific conditions, which means you need to take notes such as disturbances during the various stages of sleep, which are identified by brain waves and eye movements, which may indicate REM sleep behaviour disorder or narcolepsy. . You may also notice changes in heart rate and breathing along with changes in blood oxygen levels that indicate sleep apnea.

Other observations may include repetitive leg movements that may indicate periodic limb movement disorder or unusual movements and noises during sleep that indicate the potential for REM sleep. There are many possibilities that can only be discovered through the strong combination of skilled sleep technologists and information gathered by electrodes and sensors connected to patients.


Overview of Electronystagmography (ENG) | Neurology

What is Electronystagmography (ENG)?

Electronystagmography (ENG or electrocardiogram) is used to evaluate people with vertigo (a false sense of spinning or movement that can cause vertigo) and some other disorders that affect hearing and vision. Electrodes are set at areas above and underneath the eye to record electrical activity.

By measuring changes in the electrical field within the eye, ENG can detect nystagmus (rapid, involuntary eye movement) in response to various stimuli. If nystagmus does not occur upon stimulation, there may be a problem within the ear, the nerves supplying the ear, or certain parts of the brain. This test may also be used to distinguish lesions in different parts of the brain and nervous system.

Purpose of an ENG

ENG detects disturbances in the parts of the inner ear responsible for steering, posture, and balance, as well as in the nerves that connect your brain to your eyes and ears.

Your doctor may recommend this test if you have any of the following symptoms:

  • Severe or persistent dizziness
  • Vertigo (meaning the room is spinning)
  • Problems with balance
  • Unexplained hearing loss

Your doctor may also perform ENG if you have any of the following conditions:

  • Usher syndrome: A genetic disorder that affects vision, balance, and hearing
  • Acoustic neuroma: A benign tumor of the auditory nerve (vestibular-cochlear)
  • Labyrinthitis: Inflammation of the inner ear
  • Meniere’s disease: A problem of the inward ear that influences equalization and hearing
  • Any suspected lesion on your inner ear

What are the risks of an ENG test?

There is very little risk of Electronystagmography (ENG). A few people may encounter wooziness or sickness during the test. Electronystagmography (ENG) ought not to be utilized in the event that you have a pacemaker. The device may interfere with the pacemaker function.

Rapid changes to the posture needed for the test may worsen back or neck problems. The test for calories in water may cause mild discomfort. If you have previously been diagnosed with a perforated tympanic membrane, you should not have a portion of water calories on the ENG test.

There may be various risks depending upon your specific affliction. Talk about any worries with your medical services supplier before the strategy. Certain factors or circumstances may interfere with ENG. These include:

  • Earwax
  • Impaired vision
  • Frequent blinking
  • Certain medicines, those are sedatives, tranquilizers, and anti-vertigo medicines

How to prepare for the test?

Before the tests, you’ll likely be asked to do the following:

  • Tell your doctor about the medications you are taking: It may ask you to stop taking it 72 hours before the test.
  • Abstain from caffeine and alcohol: No drinking or coffee for 48 hours before the completion date.
  • No food: Most doctors recommend avoiding eating at least 4 hours in advance.
  • Clean your ears: Ear blockage and earwax can distort the results, so a medical assistant may wash the ear canals before the procedure if they are not clear.
  • Prepare a trip afterwards: Usually, this is good advice for many medical procedures, just in case you do not want to drive.

The test can be distorted if you have double vision or blink a lot. Also, you shouldn’t have an Injex device if you have a pacemaker for your heart. You can usually go home after your recovery, although the test can also be taken during a hospital stay. The test takes up to 90 minutes.

What happens during an electronystagmography?

So now it’s time for ENG. You might be a little hungry, you might be tired, and you might be nervous. What can you expect? In fact, the procedure includes several tests. Prior to beginning, your primary care physician will clean your brow, sanctuaries, and cheeks with liquor. Then, you attach the electrodes to those areas using a paste.

In some testing facilities, instead of electrodes, you may be provided with a binocular camera that looks like virtual reality glasses. The tests performed with this system are known as videography or VNG. These devices capture your eye movements on video and can measure them just like electrodes.

The tests include:

  • The calibration test: Utilizing just your eyes, you will be gotten some information about 6 to 10 feet away or think to and fro between focuses on a divider. This test measures visual impairment, a condition in which your pupils have difficulty judging distances to targets.
  • The tracking test: Also known as the nystagmus test, it is similar to the sobriety test offered by the police. But in Muhandis, you are usually sitting or lying down. (Nystagmus is a condition in which your eyes are out of your control.) In this test, you try to stare at a steady light, directly in front of you or at an angle, without moving your eyes around you.

There are two related tracer tests:

  • The first is the pendulum tracking test. In it, you are tracking a light that moves back and forth like a pendulum without moving your head.
  • The other is the optokinetic test, in which you track multiple moving objects without turning your head. Things may move at high speeds and enter and leave your field of vision.

The positional test: Now is the time to move your head. Often your doctor will ask you to perform what is called the Dex-Halpike maneuver. While sitting at a table, you will turn your head to one side and quickly lie down with your head – supported by your doctor – about 20 degrees below the surface of the table. You’ll remain there for 30 seconds, at that point sit upstanding once more. You will repeat it with your head on the other side. Your doctor will notice the effect on your eyes.

The water caloric test: While lying down, your doctor will inject a stream of cold or warm water into one ear, then the other. (Air is sometimes used.) If you are not vertigo, your eyes should reflexively twitch. Your doctor may not perform all of the tests. On the off chance that you have neck or back issues, she may recommend something different.

After the electronystagmography test

  • Once the test is finished, your provider will remove the electrodes and wash off the electrode paste. Do not rub your eyes to prevent spreading the electrode paste.
  • Your provider will monitor you for any signs of weakness, dizziness, and nausea. You may need to rests or sit for a couple of moments to recuperate.
  • Your healthcare provider will tell you when to start any medications you stopped taking before the test. Your healthcare provider may give you other instructions after the procedure, depending on your specific situation.
  • You may also have vertical videography (VNG). This is a test that likewise identifies eye development. But it uses video cameras instead of electrodes.


If your ENG test results are abnormal, it could indicate a problem with your inner ear or the area of the brain responsible for controlling the movement of your eyes.

Other diseases or injuries to the auditory nerve can cause vertigo, including:

  • Vascular disorders that cause bleeding in the ear
  • Ear tumors
  • Genetic disorders
  • Damage to the inner ear
  • Ototoxic drugs
  • Multiple sclerosis
  • Viral infections such as chickenpox, measles, and influenza
  • Movement disorders
  • Chemical poisoning