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Holter Monitor

ambulatory electrocardiography device A type of portable heart monitor that is a small electrocardiogram (EKG) device worn in a pouch around the neck or waist.

keeps a record of the heart rhythm, typically over a 24-hour period, and the patient keeps a diary of activities and symptoms. useful for identifying heart disturbances that are sporadic and not readily identified with a resting EKG. named for physicistNorman J. Holter who invented telemetric cardiac monitoring in 1949.

Why the Test is Performed


Holter monitoring is used to determine how the heart responds to normal activity. The monitor may also be used: After aheart attack To diagnose heart rhythm problems When starting a new heart medicine

May be used to diagnose:


Atrial fibrillation/flutter Multifocal atrial tachycardia Palpitations Paroxysmal supraventricular tachycardia Reasons forfainting Slow heart rate (bradycardia) Ventricular tachycardia

Normal Results Normal variations inheart rateoccur with activities. A normal result is no significant changes in heart rhythms or pattern. What Abnormal Results Mean Abnormal results may include variousarrhythmias. Changes may mean that the heart is not getting enough oxygen. The monitor may also detect conduction block, a condition in which the atrial electrical activity is either delayed or does not continue into the ventricles of the heart. Risks There are no risks associated with the test. However, you should be sure not to let the monitor get wet.

Considerations
Electrodes must be firmly attached to the chest so the machine gets an accurate recording of the heart's activity. While wearing the device, avoid: Electric blankets High-voltage areas Magnets Metal detectors It is very important for you to keep a diary of symptoms. The diary should include the date, time of day, type, and duration of symptoms.

medical imagingtechnique used to visualize the inside, orlumen, of blood vessels and organs of the body, with particular interest in the arteries,veinsand theheart chambers. traditionally done by injecting a radio-opaquecontrast agentinto the blood vessel imaging usingX-raybased

AngiographyorArteriog raphy

helps your physician determine the source of the problem and the extent of damage to the blood vessel segments that are being examined.

Purpose
To locate and assess narrowing, occlusions, and other abnormalities of various arteries, especially thefemoralarteries of the legs; the carotid arteries in the neck; and the arterial systems of the brain, heart, and kidneys. It also displays the vascular anatomy to organs such as the brain, liver, and gastrointestinal tract.

Advantages: - provides the most accurate information about the state of the arteries. Disadvantages - The test is invasive and carries a risk of serious complications, including an allergic reaction to the contrast material, hemorrhaging, stroke, cardiac arrhythmias, arterial occlusion, and infection. - expensive and should be performed only by an experienced angiographer.

Uses
Coronary angiography - One of most common angiograms performed is to visualize the blood in thecoronary arteries. Microangiography - commonly used to visualize tiny blood vessels. Neuro-vascular angiography - Another increasingly common angiographic procedure is neurovasculardigital subtraction

Peripheral angiography - identify vesselnarrowing in patients with leg claudication orcramps. - caused by reduced blood flow down the legs and to the feet; in patients with renal stenosis.

Coronary angiography - common and major complications. Include: -Cardiac arrhythmias -Kidney damage -Blood clots -Hypotension -Pericardial effusion Minor complications include: -Bleedingorbruising -Allergic reaction

Complications

Cerebral angiography Include: - Stroke - Allergicreaction to theanaesthetic - Blockage or damage to one of the access veins in the leg, orthrombosis - Embolismformation. Minor Complications: - Bleedingor bruising

Where It's Done Outpatient clinic, radiology lab, or hospital. Who Does It Radiologist or other doctor. How Long It Takes 1-3 hours. Discomfort/Pain Some pain as anesthetic is injected; prolonged lying on X-ray table may be uncomfortable; dye causes flushing sensation. Results Ready Often within a few hours. Special Equipment Catheter, X-ray machine, andfluoroscopic equipment; video monitor; other equipment varies according to the purpose of the test. When Risks/Complications Bleeding and a bruise where artery is punctured; allergic reaction to dye; slight risk of stroke, kidney failure, or sudden arterialocclusion.

Medications
Do NOT take any aspirin or any products containing aspirin. Do NOT take dipyridamole (Persantine) or warfarin (Coumadin)within 72 hours before the test, and 24 hours after the test.These medications are often referred to as blood thinning pills. DO take your other medications on schedule as usual, especially any medications for high blood pressure.

ARTERIOGRAPHY
Radiologic examination of arteries using a contrast medium that is injected into an artery to make arteries visible. Performed most often usingx-ray, althoughmagnetic resonance imaging (MRI) andcomputed tomography(CT scan) may also be used. When an x-ray or CT scan study is performed, a liquid, radio-opaque dye is used.

Usually performed under local anesthesia. It may also be performed in the operating room under general anesthesia during arterial graft surgery.

Complications
The most common complication of arteriography is formation of a blood clot (thrombus) in the artery at the entry site. Other complications include: - an allergic reactionto the dye, - bleeding from the puncture site, - dislodgment of plaque from the inside of the artery (embolization), - separation of the wall of the artery (dissection), -infection - stroke.

Restrictions/ Accommodation
Ordinary walking and a return to work the same day or the next day are usually allowed. If work involves lifting more than 20 pounds or a lot of bending , 2 or 3 days off work are recommended to reduce the chance of re-bleeding from the entry site. Bending of the groin or elbow at whatever site was used for performance of the arteriography should be avoided for 1 day. A longer restriction of activity may be required if an individual sustained a complication from the procedure.