An event monitor is a portable device used to record your heart’s electrical activity when you have symptoms. It records the same information as an electrocardiogram (ECG), but for longer durations of time. Most of these devices can transmit the recorded information directly to your healthcare provider. This allows him or her to analyze the electrical activity of your heart while you are having symptoms.
Normally, a special group of cells begin the electrical signal to start your heartbeat. These cells are in the sinoatrial (SA) node. This node is in the right atrium, the upper right chamber of the heart. The signal quickly travels down the heart’s conducting system on the way to the ventricles, the two lower chambers of the heart. As it travels, the signal triggers nearby parts of the heart to contract. This helps the heart contract in a coordinated way.
ECGs and event monitors are used to help analyze this electrical signaling through the heart. These tests are very helpful in diagnosing a variety of abnormal heart rhythms and medical conditions. A standard ECG only records the heart signal for a few seconds, and it is not portable.
An event monitor is very similar to something called a Holter monitor. This is another portable device used to analyze the heart’s signaling. Holter monitors record continuously, usually for about 24 to 48 hours. An event monitor does not record continuously. Instead, it records when you activate it. Some event monitors will automatically start recording if an abnormal heart rhythm is detected. Event monitors can be worn for a month or longer.
There are two main types of event monitors: symptom event monitors and memory looping monitors. When you activate a symptom event monitor, for the next few minutes, it records the information from the heart’s electrical signal. A memory looping monitor does the same thing. However, it also records the information from a few minutes before the device was activated, so data from before, during and after the symptom will be captured.
Why might I need to use an event monitor?
Sometimes a healthcare provider may suspect that you have an abnormal heart rhythm based on your medical history, even if your ECG looks normal. Certain abnormal heart rhythms happen infrequently and temporarily. A random ECG is unlikely to pick up your abnormal heart rhythm if this is the case. An event monitor may be a better option for you. That way, you can record your heart’s electrical activity when you are having symptoms from your abnormal rhythm. Wearing the event monitor can help determine whether you have an abnormal heart rhythm. If you do have an abnormal rhythm, the event monitor can help determine what type.
You may need to wear an event monitor if your heartbeat is abnormally fast, abnormally slow, or irregular. If you are already being treated for an abnormal heart rhythm, your event monitor may be used to see how well it is working.
You may need an event monitor to evaluate certain kinds of temporary symptoms, such as palpitations. You might feel that your heart is beating too hard or skipping a beat. Dizziness and fainting are other symptoms that might be signs that you need an event monitor.
What are the risks for using an event monitor?
Event monitors are completely safe. They do not cause any pain. Sometimes the sticky patches used to attach the sensors to your chest can cause skin irritation.
How do I prepare for using an event monitor?
Your healthcare provider will show you how to use your event monitor. There are different types of event monitors that all work in different ways.
Cardiac memory loop monitors have sensors that attach to your chest using sticky patches. Wires connect these sensors to a monitor, which you can usually put on your belt or in your pocket. Before you put your sensors on your chest, your skin should be free of oils, creams, and sweat. Clean your skin before putting them on. You may need to shave the area before applying. A technician will show you how to place the electrodes.
Cardiac event recorders may not have sensors that attach to your chest, such as post-event recorders. Some models are handheld, and others attach to your wrist. For some of these models, you need to push the button on your wrist when you feel symptoms. In other models, you need to hold the recorder up to your chest in order to record.
What happens while using an event monitor?
In general:
- If you have a cardiac loop monitor, change your sensors as instructed.
- When you have a symptom, push the button to start recording. (Some start recording automatically when an abnormal rhythm is detected.)
- After you do this, stop moving. This will help the device get a good recording. The device should record for several minutes.
- For some event monitors, you will need to send your recordings over the phone to your healthcare provider.
- Someone will review your recording. In some cases, you may need to go see your healthcare provider.
- Follow all instructions about exercise. Sweat can make the sensors come off.
- If you can, avoid items that can disrupt the event monitor. These include magnets, metal detectors, microwave ovens, electric blankets, electric razors, electric toothbrushes, cell phones, and iPods. You will receive specific instruction at the time the monitor is placed.
- When you need to use an electronic device, keep it at least 6 inches away from the monitor.
You will also need to keep a diary while using your event monitor. Record any symptoms when they happened, and note what you were doing at the time. You may need to wear your event monitor for several days or up to a month.
What happens after using an event monitor?
Ask your doctor about what you can expect after you use an event monitor.
After a few readings, you may be able to stop wearing your event monitor. Your healthcare provider may use those readings to start your treatment. In some cases, more testing maybe needed. Follow-up tests might include:
- Exercise stress test, to see how the heart responds to exercise
- Tilt-table test, if you have had fainting
- Electrophysiological testing, to get more information about the heart’s electrical signal
- Echocardiogram, evaluate the structure and pumping function of the heart
Next steps
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
ECG Ch. 13
As a health care professional, your responsibilities with the ambulatory monitor include which of the following?
Applying and removing the monitor
Which of the following is an instrument that records the electrical activity of the heart during a patient's normal daily activities?
How long does an ambulatory monitor typically record an ECG?
How many leads are attached to a patient's chest with ambulatory monitoring?
What is another term for loss of consciousness (fainting)?
What is the term for fast, irregular heartbeat sensations felt by the patient, which may or may not be associated with complaints of chest pain?
Which of the following is not a reason to use an ambulatory monitor?
To evaluate oxygen utilization by the myocardium
Why might ambulatory monitoring be used in addition to 12-lead ECG monitoring?
The patient was complaining of palpitations but did not have any symptoms during the 12-lead ECG
Which type of monitoring device can be implanted under the skin with a single lead?
Which type of ambulatory monitoring requires the patient to keep a diary of all daily activities, abnormal experiences, and symptoms?
Which type of monitoring device can hold up to 96 hours of data and allows licensed practitioners to capture significant cardiac events even when the patient is not experiencing symptoms?
Which type of ambulatory monitoring device is often used in a hospital?
When would a patient use an event marker during ambulatory monitoring?
To mark the ECG tracing when symptoms occur
Which patient will be asked to keep a diary?
Ms. Fisher, whose physician ordered Holter monitoring this morning
Mrs. Hansen has an ambulatory monitor in place. What instructions do you give her regarding the electrodes?
If an electrode becomes loose, she should press it in the center to reapply; however, she must return to the clinic if one comes off completely
Which of the following instructions would be given to a patient scheduled for ambulatory monitoring?
Wear a loose-fitting shirt, preferably one that buttons down the front, and you will be more comfortable during the procedure
During ambulatory monitoring, which of the following would not be recorded in the patient diary?
Trimming fingernails or toenails
When a Holter monitor is used, when should the patient start his or her diary?
When the monitor is turned on
Which of the following devices should a patient avoid while wearing an ambulatory monitor?
When asked by a patient or the parent of a patient whether ambulatory monitoring is painful, what would be your best response?
The monitoring is not painful; however, there may be some discomfort while the electrodes are in place
When preparing a patient for ambulatory monitoring, it is important to ensure that which of the following occurs?
The patient understands the physical requirements of the monitoring procedure
You need to prepare a 10-year-old boy for an ambulatory monitoring procedure. Which of the following should you include in your patient teaching?
Allow the child to touch the equipment before applying it
You are putting a new type of ambulatory monitor on Mrs. Farmer. It uses a five-lead system that is unfamiliar to you. What should you do before placing the electrodes?
Consult the manufacturer's instructions; they are the best resource for using new equipment
What should be done with a Holter monitor before entering a patient's room to begin the procedure?
Insert new batteries in the monitor
Mr. Benson's Holter monitor was applied yesterday at 9:00 am. At that time, he was told to return this morning at 9:00 am to have the monitor removed. He arrives at 10:30 am but did not bring his diary. What should you do?
Ask him to return home to get the diary before removing the monitor
Which of the following is a correct statement regarding the results received from an outside laboratory for ambulatory monitoring?
Results will be available in 7 to 10 days and placed on the chart for the physician to discuss with the patient
Mr. Freeman asked you about the results of his test. You saw the final report and know there were abnormalities. How do you respond?
You tell him he needs to discuss the results with his physician
Which of the following cardiac conditions cannot be confirmed by performing an ambulatory monitoring test?
What is the first step in reducing a patient's fear of ambulatory monitoring?
Help the patient understand the procedure
Which of the following activities is not allowed during ambulatory monitoring?
For ambulatory monitoring, why is it recommended that chest hair should be clipped, not shaved?
Clipping reduces the chance that the patient will scratch the skin, causing an artifact on the tracing
What is the proper procedure for connecting electrodes for ambulatory monitoring to reduce tugging and pulling during patient movement?
Tape the electrodes in place
What does the term ambulating mean?
What is another name for a stress ECG?
Exercise electrocardiography
Once the patient turns in the ambulatory monitor and diary, who is the person that typically provides the final interpretation of the ambulatory monitoring data?