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Holter test

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by vli, Oct 13, 2013.

  1. vli

    vli

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    Please forgive any typos as I am writing on a phone. My mother took me to a gov hospital here in Hong Kong after I'd complained for weeks abt chest pain. They've done an electrocardiogram, an ECG, chest x ray n now they want to do a holter which means another 2 days at the hosp as Mon. here is a public hol... :( my Q is, are Holters even accurate? My symptoms are basically all the OI and mitral valve prolapse symptoms that Dr Enlander said I had a year ago but I never did any tests. Anyone here w cardiac symptoms who were "cleared" by a Holter? Thamk u so much.

    P.S. altho I can't leave for 4 days, my mother took me here bc it is free.
     
  2. svetoslav80

    svetoslav80 Senior Member

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    I've done electro and echo cardiograms , and Holter and I have mitral valve prolapse too. The prolapse and chronic fatigue sometimes cause slight arrhytmia for me, but fortunately this does not happen very often. The doctor said my heart is otherwise healthy, and this is one of the few cases where I actually believed him. If you've done the heart tests and they were OK, I think you should be calm that you don't have a heart disorder. Unlike the lyme disease tests, heart tests are quire accurate. If you have arrhytmia, it is most probably caused by CFS (or something else), but not heart disorder. This doesn't explain your chest pain, though, but at least you know that it is not heart related. I'm also not quite familiar with the OI symptoms.
     
  3. vli

    vli

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    Ok, thank u. I guess I was worried a holter wld miss a lot of our abnormalities, bc we don't hv "heart disease", and we won't get things that we might otherwise get (be that blood thinners or a pacemaker or whatever). Has anyone else had this experience?
     
  4. Sushi

    Sushi Moderator and Senior Member Albuquerque

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    Why not get an echocardiogram too while you are there? It will show things that that the holter won't. Can they also do a TTT for you while you have the holter on? That would likely show things more specific to ME/CFS.

    Sushi
     
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  5. ahimsa

    ahimsa Senior Member

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    It's not whether a holter monitor is accurate or not. The question is what does a holter monitor measure?

    I think they are pretty good for picking up an arrhythmia (irregular heart beat) if that is your problem. And a holter monitor can also measure an increased heart rate. But a fast heart rate may or may not be due to OI (Orthostatic Intolerance).

    Speaking only for myself, the holter monitor tests that I have had done did not lead to any diagnosis or any helpful information for treatment. The tests did show some some indirect evidence for my type of OI (Neurally Mediated Hypotension) because they showed an increase in heart rate. And there were extra PVCs and so on. (there may have been abnormal T-waves but my tests were done long before that ME/CFS research on T-waves came out).

    But these things were noticed by me only in hindsight. At the time the doctor just said "everything's normal" (meaning "no arrhythmia was found") and I was back at square one.

    It may be different for someone with POTS where the primary problem is an increase in heart rate. But even then I think the doctor would need to observe that you are standing still in order to verify that the heart rate increase happens for that reason and not for some other reason.

    So while I don't think a holter monitor is completely useless (it may help rule out other problems) I don't know whether it can ever be used to diagnose OI.

    I second Sushi's suggestion to see whether they can do a Tilt Table Test (also called a Head-Up Tilt) if you suspect some kind of autonomic dysfunction.
     
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  6. ukxmrv

    ukxmrv Senior Member

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    The Holter test I had at a London hospital was reported as normal. However the TT test was abnormal but there was a lot of resistance to doing this after the Hotler. They dumped at at that point and refused any further investigations.. I had a private TT test eventually.

    Good luck Vli
     
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  7. vli

    vli

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    thanks to everyone for kindly replying. they let me out today.

    Sushi... I couldn't "dictate" what i wanted because i was in a similar pos'n as ukxmrv, being in a gov hosp there was no way i could ask for anything that was outside their procedure; the holter was ordered after they did an echo which the doc said showed nothing... as one could expect.

    having read ahimsa's post, i suspect my holter won't show anything either. from what i understand, the holter measures arrhythmia, so if that IS what one's looking for, the holter should be accurate in picking it up, or not? No medical professional's ever diagnosed me with arrhythmia, even though I FEEL like my heart beat's all over the place. Or I suppose the question is, a person can have some MVP and arrhythmia and the two aren't mutually exclusive, no?

    thanks everyrone for all ur help.
     
  8. Sushi

    Sushi Moderator and Senior Member Albuquerque

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    The problem is often the person reading the holter not the holter itself. I've had them ignore minor arrhythmias -- regarding them as with the "normal" range.

    MVP and arrhythmias are not mutually exclusive though the MVP is unlikely the cause the arrhythmia. The arrhythmias usually are coming from the ANS. Hence, getting an TTT if you really want to investigate this.

    Sushi
     
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  9. SOC

    SOC Senior Member

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    I have heard that it sometimes helps to be more than normally (for you) active while you are wearing the Holter monitor and to keep a close record by time of your physical activity. Doctors are far too good at assuming, and in the case of the Holter test they are probably assuming that you are as active as a healthy person and interpret the results accordingly.

    I think the idea behind extra activity is that if you are resting normally for a PWME, some of the cardiac abnormalities don't occur because you are not putting the necessary demands on your cardiovascular system. Part of the reason we don't stand for long periods, climb stairs, or go from sitting to standing frequently is to avoid the bad symptoms, but if we want the docs to see the way our bodies react, we have to make sure the reactions happen when the doc is "watching". Just make sure you can tell the doc what you were doing the whole time so that if s/he sees something odd in the Holter results, you can show what activity might be causing it.

    My multiple Holter tests showed the usual T-wave flattening, but nobody seemed to think that was any big deal. Tachy was pretty evident, however. I'm not convinced the Holter test shows much for ME/CFS, but it might cause a doc to pass on more telling tests, like a TTT, if the Holter test results are too normal (if you know what I mean).
     
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