Holter monitor and ECG in Perth

A 12-lead ECG and a Holter monitor both record the electrical activity of the heart. An ECG takes a few minutes in the rooms and gives a snapshot of the rhythm. A Holter monitor is worn home and records every heartbeat for 24 hours or longer, so rhythm problems that come and go can be caught. eCardiology performs both tests at all six of its sites in Perth and regional Western Australia, and the recordings are reported by its cardiologists.

What a 12-lead ECG is

An electrocardiogram, or ECG, records the electrical signals that make the heart beat. Ten sticker electrodes are placed on the chest, arms and legs and connected to a machine that prints twelve views of the heart's electrical activity, which is why it is called a 12-lead ECG. It is one of the simplest and most widely used heart tests.

What an ECG can show

An ECG shows the heart rate and whether the rhythm is regular; rhythm problems such as atrial fibrillation or extra beats; signs of a previous heart attack, or of one happening now; thickening of the heart muscle, often related to high blood pressure; problems with the heart's electrical wiring, such as heart block; and some inherited heart conditions. An ECG is a snapshot of a few seconds. If symptoms come and go, the tracing may be normal between episodes, which is why a cardiologist may also order a Holter monitor.

What a Holter monitor is

A Holter monitor is a small, portable recorder that records the heart's rhythm continuously while you go about your normal day. It is essentially a long-running ECG. A standard ECG lasts only a few seconds, so it can miss problems that come and go. A Holter monitor records every heartbeat for 24 hours, and sometimes longer, so that intermittent rhythm problems can be caught.

Why a cardiologist orders these tests

An ECG is part of almost every cardiology assessment. It is used to investigate palpitations, chest pain, dizziness or fainting and breathlessness, to check the heart before surgery, and to monitor the effect of some medicines. For Telehealth consultations, eCardiology asks for a recent ECG to be sent with the referral so the cardiologist can review it during the appointment.

A Holter monitor is commonly used to investigate palpitations (a racing, thumping or fluttering feeling in the chest); dizziness, light-headedness or fainting; suspected atrial fibrillation or other irregular rhythms; unexplained stroke, where a hidden rhythm problem may be the cause; whether a slow heart rate or pauses are occurring; and how well a rhythm medicine or a pacemaker is working.

What happens on the day

ECG: you undress to the waist and lie on an examination bed. The skin may be wiped, and occasionally a small patch of chest hair shaved, so the stickers attach well. Ten stickers are placed on the chest, wrists and ankles and connected by leads to the ECG machine. You lie still and breathe normally for about ten seconds while the recording is taken. The whole test takes around five to ten minutes and is painless.

Holter monitor: a technician attaches sticker electrodes to your chest, connected to a small recorder that you wear. Fitting takes about 15 minutes. You then go home and carry on with your usual activities, including work and exercise. The recorder must stay dry, so showering and swimming are not possible while it is on. You keep a simple diary of your activities and note the time of any symptoms, so the recording can be matched to what you felt. After the recording period you return the device to the practice.

How to prepare

No special preparation is needed for an ECG. Eat, drink and take your medicines as usual, wear a top that is easy to remove, and avoid body lotion or oil on the chest on the day, as it stops the stickers sticking.

For a Holter monitor, shower before the fitting appointment, since you will not be able to while wearing it. Do not apply lotion, oil or powder to the chest. Wear a loose top rather than a dress or one-piece garment, which makes the leads awkward. Take your usual medicines unless told otherwise.

Risks and limitations

Both tests are safe. They record signals from the body and do not send anything into it. A few people get mild skin irritation from the stickers. The main limitation is time. An ECG only captures the moment of the recording, so it can miss intermittent problems, and it cannot show the heart's structure or the state of the arteries; an echocardiogram or a CT coronary angiogram is used for that. If your symptoms only happen once every few weeks, a 24-hour Holter recording may not catch them either. Your cardiologist may then recommend a longer recording, an event monitor you activate when symptoms occur, or a small implanted loop recorder.

Results and follow-up

An ECG done at an eCardiology consultation is read by the cardiologist during the appointment. An ECG sent in with a Telehealth referral is reviewed when the referral arrives. A Holter recording holds around 100,000 heartbeats for each day worn; the data is analysed by software and then reviewed and reported by the cardiologist. The report goes to your referring doctor and is discussed with you at a follow-up appointment, in person or by Telehealth.

Referral and booking

A referral from your GP or another doctor is needed. ECGs and Holter monitors are done at all six eCardiology locations: Perth CBD, Joondalup, Mandurah, Albany, Canning Vale and Midland. To book, call (08) 9468 5578 or use the Request an appointment page.

Frequently asked questions

Can I go to work while wearing a Holter monitor?

Yes. The recording is most useful when you do your usual activities, including anything that normally brings on symptoms.

What if a sticker comes off?

Press it back on if you can. If it will not stick, note the time in your diary and contact the practice for advice.

Can I sleep with the monitor on?

Yes. Place the recorder beside you or under the pillow so the leads are not pulled.

Is a smartwatch ECG the same as a 12-lead ECG?

A smartwatch records a single lead and can be useful for catching an irregular rhythm at home. A 12-lead ECG gives a much fuller picture and is the standard used for diagnosis.