Holter Monitoring & Ambulatory ECG Flashcards
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Read the first 7 Holter Monitoring & Ambulatory ECG flashcards as text
An implantable loop recorder (ILR) differs from a traditional Holter monitor in that the ILR:
Answer: Is subcutaneously implanted and can record for up to 3 years
ILRs are small subcutaneous devices implanted under the skin that can continuously monitor cardiac rhythm for up to 3 years, used for infrequent unexplained syncope.
A Holter shows a heart rate that abruptly doubles from 75 to 150 bpm with a narrow QRS. The MOST likely mechanism is:
Answer: Paroxysmal supraventricular tachycardia (PSVT)
An abrupt doubling of rate with narrow QRS is the hallmark of PSVT, which begins and ends suddenly unlike the gradual rate change of sinus tachycardia.
Which artifact pattern on a Holter recording mimics atrial fibrillation and is caused by patient movement?
Answer: Muscle (myopotential) artifact producing irregular rapid deflections
Myopotential artifact from muscle movement produces irregular, rapid, low-amplitude deflections that can mimic the chaotic baseline of atrial fibrillation.
A patient with a pacemaker undergoes Holter monitoring. The technician notices pacemaker spikes not followed by QRS complexes. This finding indicates:
Answer: Pacemaker failure to capture
Pacemaker spikes not followed by a paced QRS indicate failure to capture, meaning the pacemaker stimulus did not depolarize the myocardium.
During Holter application, the technician marks the recorder's event time using the patient's watch. At analysis, the technician discovers the recorder clock and the watch were 22 minutes apart. The correct action is to:
Answer: Add a notation to the report documenting the time discrepancy
Documenting the clock discrepancy allows the interpreting physician to correctly correlate diary entries with actual recording times when reviewing the report.
A 7-day patch monitor is MOST appropriate compared to a standard 24-hour Holter for patients with symptoms occurring:
Answer: Every 2–4 weeks
Extended wear monitors are indicated when symptoms occur less frequently than daily, as a 24-hour Holter is unlikely to capture infrequent arrhythmic events.
Which of the following heart rate variability (HRV) parameters derived from Holter monitoring is a time-domain measure?
Answer: SDNN (standard deviation of all NN intervals)
SDNN is a time-domain HRV measure representing the standard deviation of normal-to-normal R-R intervals over the recording period.