Holter ECG and the evaluation of patient’s symptoms
Various symptoms can be correlated with ECG alterations (arrhythmias as well as ischemia). A simultaneous ECG registration during a symptomatic period excludes or confirms ECG alterations as cause of the symptoms. Otherwise symptoms can be probably related to arrhythmias or ischemia, if asymptomatic precursors of a specific symptom, e.g. syncope can be found in the ECG record.
The continuous recording of an ECG over a long period (24 hr and more) enhances the chance to correlate symptoms with the ECG.
Prior to Holter monitoring (HM) 63% of the patients (total 2420 HM) had a history of one (59%) or more (41%) symptoms. During one 24 hr HM only 20% developed a typical symptomatic period, 85% patients with a symptomatic history. In 60% (290/480 HM) arrhythmias could be excluded as underlying cause of the symptoms.
Palpitations prior to HM were reported in 17-31% of the patients. During HM about 56% of the symptomatic patients complained of palpitations, whereas in 37-47% arrhythmias could be related to the symptom.
Dizzy spells, presyncopes and syncopes were reported prior to HM in 25-53%, during HM in 56-65% of the symptomatic patients, whereas in 37-47% a morphologic substrate could be found in the Holter-ECG. Therefore in patients with SY precursing arrhythmias should be taken into account, which could be detected in 36-46%. Otherwise 40-54% of patients with SY had completely uneventful HM.
Angina prior to HM occurred in 13% among our patients. During HM 20% developed typical symptoms and ST-depression, whereas 67-80% of ST-alterations were ‘silent’.
KeywordsMitral Valve Prolapse Holter Monitoring Mitral Valve Disease Holter Record Morphologic Substrate
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- 1.Dolotta TA, Olsson SB, Petrucelli AG (1980) UNIX User’s Manual, Bell LaboratoriesGoogle Scholar
- 2.Joskowicz G, Balatka H, Glogar D, Weber H, Steinbach K (1979) A high speed digital Holter tape analysis with full editing capability. IEEE Proc Comp Card pp 277–279Google Scholar
- 5.Braunwald E (1980) Heart Disease; WB Saunders Comp, p 9Google Scholar
- 6.Burckhardt D, Luetold BE, Jost MV, Hoffmann A (1982) Holter monitoring in the evaluation of palpitation, dizziness and syncopes, In: Roelandt J, Hugenholtz PG (eds) Long-term ambulatory electrocardiography. Dordrecht: Martinus Nijhoff Publishers, pp 29–39Google Scholar
- 7.Mueller C, Kiss H, Weber H, Kaindl F (1986) Longterm ECG in patients with syncopes. Z Kardiol 75:730–736Google Scholar
- 8.Snellen HA (1984) History of cardiology. Rotterdam: Dorher Academic Publications, p 137Google Scholar
- 9.Johansson BW (1980) Evaluation of alterations of consciousness and palpitations. In: Wenger NK, Mock MB, Rinquist I (eds) Ambulatory electrocardiographic recording. Year Book Med Publ pp 321–330Google Scholar
- 12.Cohn PF (1980) Silent myocardial ischemia in patients with a defective anginal warning system. Am J Cardiol 10:59–69Google Scholar
- 13.Pepine CJ (1978) Asymptomatic myocardial ischemia during daily activities. Observations in persons with and without coronary heart disease. In: Stern S (ed.) Ambulatory ECG monitoring. Year Book Med Publ, Chicago: p 107Google Scholar
- 15.Weber H, Joskowicz G, Kiss H, Glogar D, Steinbach K, Probst P, Kaindl F (1985) Transtelephonic telemetry of cardiac arrhythmias and pacemaker surveillance. In: Hombach V, Hilger HH (eds) Holter monitoring technique. Stuttgart - New York: Schattauer Verlag, pp 75–84Google Scholar
- 17.Doherty JU, Pembroo-Rogers D, Grogan EW, Falcone RA, Buxton AE, Marchlinski FE, Cassidy DM, Kienzle MG, Almendral JM, Josephson ME (1985) Electrophysiologic evaluation and follow-up characteristics of patients with recurrent unexplained syncope and presyncope. Am J Cardiol 55:703–708PubMedCrossRefGoogle Scholar