Holter monitor

Holter monitor

What is the  holter monitor?

The  holter monitor is a portable 24-hour recording device that measures your hearts activity.

Why do you need the holter monitor?

  • Many heart problems can only be revealed during activity, such as exercise, eating, stress or even sleeping. With the holter monitor, it is easier to record these transient rhythm disorders or silent ischemia episodes.
  • In addition, the type of arrhythmia, its duration, but also its relationship to the symptoms reported by the subject (heart pain, dizziness, fainting, syncope) can be studied.
  • It is also important to use it in monitoring the anti-arrhythmic treatment likely to be received by the subject.

What should you tell the doctor before the test?

It is advisable to report all prescription and non-prescription medicines you receive. It will also help to interpret the results, the existence of older electrocardiograms or rhythm holter reports.

How to Prepare?

Wear comfortable clothes that are not too tight. Avoid jewelry and clothes with metallic objects, as they can cause parasites during recording.

What is the procedure?

A small, portable device is placed in the patient’s waist or neck. With the help of 5-7 cables, it is attached to self-adhesive electrodes, which are placed in defined positions of the chest wall.

What do you have to do during the examination?

You may be asked to record various events or activities in a calendar. In this way, it is easier to correlate symptoms with electrocardiographic changes in the holter.

When you sleep, try to stay upright with the recorder on the side for better recording quality.

In case any of the electrodes or cables are removed, an audible signal will be heard. Try replacing the cable. If this is not possible, contact your doctor.

Avoid using an electric toothbrush or shaving machine as it is likely to cause parasites.

At the end of the recording, you should return to the clinic to analyze the recorded electrocardiogram on the computer.

What do you need to know about the results of the examination?

A doctor should interpret the holter monitor
The results of the test are compared with the symptoms reported by the subject
It is likely that during 24-hour recording, no symptoms or the quality of the electrocardiogram would be desirable. In this case, a second placement of the holter may be required.

Ioannis Tzanogiorgis, Cardiologist, Athens

Ambulatory Blood Pressure Monitor

Ambulatory Blood Pressure Monitor

Ambulatory Blood Pressure Monitor

The ambulatory blood pressure monitor (ABPM) is a non-invasive method of measuring blood pressure for 24 hours while the patient continues his daily activities. It includes the measuring device and the cuff, while the recorded values ​​will be analyzed after the end of 24 hours, using special software.

What is the use of 24-hour monitoring?

  • 24-hour recording (by pressure monitor) may be more reliable than individual measurements at home or in the office.
  • In detecting “white coat’ hypertension  (increased blood pressure in the clinic but normal throughout the rest of the day)
  • To control the response to treatment
  • To detect masked hypertension (normal blood pressure values ​​at the clinic but increased the remainder of the day)
  • For research purposes

Which patients should be referred for Ambulatory Blood Pressure Monitor?

According to the guidelines of the European Cardiology Society issued in 2013, a 24-hour indication for ABPM have:

  • Patients who are suspected of having a white coat hypertension or masked hypertension
  • Patients with significant blood pressure variability in the clinic, on the same or different visits
  • Pregnant with suspicion of preeclampsia or with increased blood pressure in the clinic
  • Patients with resistant hypertension, to figure out if it is true or not
  • If there was a significant discordance of blood pressure recorded in the office with that recorded at home.
  • But also patients with hypertension at night (patients with sleep apnea, chronic kidney disease or diabetes)

What are the normal values?

Normal values ​​in the 24-hour recording are lower than those performed in the clinic. Normal values ​​are <135 / <70 mmHg during the day, while at night the values ​​should be <120 / <70 mmHg.

How often are the measurments?

Blood pressure measurements are usually done every 15-30 minutes during the day and every 30 to 60 minutes during the night.

Are there any disadvantages  using ambulatory blood pressure monitor?

As with any examination, there are limitations and drawbacks.

  • Restrictions on availability
  • Technical difficulties, related to the training of the doctor, who makes the recording
  • Inability of many patients to tolerate the cuff for 24 hours.
  • Sleep disorder due to device-generated noise.
  • Arrhythmias, which may affect the results.

Ioannis Tzanogiorgis, Cardiologist, Athens

Treadmill stress test

Treadmill stress test

What is the treadmill stress test?

The treadmill stress test  is a basic cardiology test that helps the doctor to see how the heart reacts to the effort. As the effort increases, the body needs more oxygen. This causes the heart to draw more blood. The test will show whether the blood supply to the arteries of the heart (coronary arteries) is reduced. It will also help the doctor to determine the type and intensity of exercise that is appropriate for each patient.

In which cases is it necessary?

The treadmill stress test is necessary:

  • For the diagnosis of coronary heart disease
  • To evaluate symptoms that are probably related to heart problems (chest pain, shortness of breath, dizziness)
  • Estimate the effectiveness of previous cardiac procedures.
  • But also the medication that the patient receives for his heart.
  • Prediction of the possibility of a heart attack.
  • Assess the level of exercise that is safe for the person tested.
  • And of course in the context of a more general assessment of the patient’s health, especially in the case of a new exercise program.
What is the procedure for the treadmill stress test?

The self-adhesive electrodes are placed on the chest of the person tested and connected to an electrocardiograph. This helps to monitor the heart  rate throughout stress test.

The test is divided into 3-minute stages, with a progressively increasing speed and slope of the treadmill. In this way, the fatigue of the subject is achieved.

The process resembles the rise to a small hill. Blood pressure is measured at regular intervals while the doctor is constantly on the side of the subject. Exercise can be stopped at any time, if necessary.

At the end of the exercise, the person tested will be lying for a few minutes until the blood pressure and heart rate are restored.

What do I need to know before treadmill stress test?

The physician who will perform the test must be informed of the medical history. Prior to testing, he should be informed of possible symptoms such as chest pain or shortness of breath.

It is good to have an echocardiogram to rule out certain situations that can be dangerous.

The patient should receive the usual medication unless the doctor recommends stopping a drug.

You are not allowed to eat 2-3 hours before the stres test, and it is advisable to avoid smoking.

Clothes and footwear must be suitable for walking.

Is there a risk during the treadmill stres test?

The treadmill stress test is generally considered safe. This is accomplished by good patient preparation, correct medical history, full cardiac control. This results in a correct risk assessment.

But the risk is not non-existent.

Angina pectoris, fainting episodes, syncope, myocardial infarction, arrhythmias are some of the most serious complications.

Are there restrictions after the treadmill stress test?

There is no particular limitation and the person tested can continue his normal activities.

Ioannis Tzanogiorgis, Cardiologist, Athens

Ankle-brachial index

Ankle-brachial index

Ankle-brachial Index (also called ABI)
What is the Ankl-brachial Index?

Measuring ankle-brachial index (ABI) is a simple, easily reproducible and accessible test that can accurately highlight the presence of peripheral artery disease.

Peripheral artery disease is a condition in which the arteries of the legs or the upper extremities are narrowed. Studies show that patients with peripheral artery disease have an increased risk of developing cardiac events and stroke.

How is the test performed?

During the test, blood pressure is measured at the upper and lower extremities. This presupposes that the examined person is lying down. Blood pressure is then measured at all four extremities, using a cuff and a doppler device. In some cases it may be useful to measure pressure after exercise in a treadmill. When the measurements are taken, the subject’s ankle-brachial index is calculated. An ABI of less than 0.9 is considered abnormal and may indicate the presence of stenosis in the lower limb arteries.

In which cases is it necessary to measure the ankle-brachial index?

Peripheral artery disease, like coronary artery disease, may have symptoms only when it is at an advanced stage. It is therefore necessary to look for those who have an increased risk of developing it.

  • Smokers or ex-smokers over 50 years of age
  • Diabetics
  • Patients with arterial hypertension
  • Those with elevated lipids
  • People over 70 years of age

And of course patients reporting symptoms suspected of peripheral artery disease. These may be pain or cramps in the legs during walking that disappear in rest (also called intermittent claudication). Even sores in the legs that do not heal easily or not at all. Cold lower extremities compared to the rest of the body.

What do the results show?

An ankle-brachial index value between 0.9 and 1.3 is considered normal.

Values ​​below 0.9 indicate peripheral artery disease. Specifically,  values ​​below 0.4 indicate a significant degree of peripheral angiopathy. While values ​​from 0.41 – 0.9 are indicative of small or moderate degree of peripheral angiopathy and may be accompanied by intermittent claudication.

Values ​​from 0.91 to 0.99 are considered to be to the limits, and in the presence of indications, it may be required to measure the ankle-brachial index after exercise.

Finally, values ​​above 1.3 (or 1.4 by other researchers) show hard vessels and usually occur in patients with diabetes or chronic renal failure.

What are the next steps?

The measurement of abnormal ankle-brachial index is the trigger for further control of the cardiovascular system and risk factors. As mentioned above, patients suffering from peripheral artery disease are more likely to develop coronary artery disease or stroke. Therefore, a full cardiac check up is necessary to assess the presence of coronary heart disease or the presence of angiopathy in other parts of the vascular system.In addition, cardiac risk factors (arterial hypertension, dyslipidaemia, smoking, obesity, sedentary lifestyle) should be sought and evaluated and appropriate guidance given. Finally, further angiological testing is likely to be required to better assess the extent of angiopathy.

Ioannis Tzanogiorgis, Cardiologist, Athens