You know that fluttery feeling you sometimes get in your chest? Or maybe a sudden racing heart that just… appears out of nowhere and then vanishes? I hear about these kinds of fleeting moments a lot in my clinic. You come in, we do an electrocardiogram (EKG or ECG for short) – that’s the test with the sticky pads that gives us a snapshot of your heart’s electrical activity – and, wouldn’t you know it, everything looks perfectly normal. It can be so frustrating, for you and for me! That’s exactly when we might talk about using ambulatory monitors. These clever devices help us see what’s happening with your heart over a longer time, while you’re just living your life.
So, What Exactly Are Ambulatory Monitors?
Think of ambulatory monitors as little detectives for your heart. They’re portable gadgets you can take home, and they keep an eye (or an ear, really) on your heart’s electrical rhythm as you go about your day – working, sleeping, all of it. Their main job is to help us catch those sneaky heart rhythm problems, which we call arrhythmias.
An arrhythmia simply means your heart isn’t beating in its usual, steady pattern. It could be:
- Bradyarrhythmias: When your heart beats too slowly.
- Tachyarrhythmias: This is when your heart races too fast.
- Supraventricular arrhythmias: “Supra” means above, and “ventricular” refers to the lower chambers of your heart. So, these are irregular rhythms starting in the heart’s upper chambers (the atria).
- Ventricular arrhythmias: These are rhythm problems that begin in the heart’s lower chambers (the ventricles).
While an EKG in the office gives us a quick look, an ambulatory monitor gathers much more information. It can spot arrhythmias you don’t even feel, or ones that pop up unpredictably.
Your heart has its own amazing electrical system, kind of like wiring, that tells it when to beat. This electrical activity is what these monitors pick up through sensors, usually called electrodes, that stick to your skin. If a part of your heart isn’t working quite right, the electrical signals change, and that’s what we’re looking for.
The Different Kinds of Ambulatory Monitors
It’s not a one-size-fits-all situation, which is great! We have a few different types of ambulatory monitors, and we’ll choose the one that makes the most sense for what we’re trying to find out.
Most are external devices, about the size of a small phone, that you carry with you. The electrodes on your chest connect to the device. Here are the common ones:
- Holter Monitors: This is a common one. You’ll typically wear it for 1 to 2 days, though some newer ones can go for a week or two. It records everything continuously.
- Event Monitors: These are smart because they only record when an arrhythmia is likely happening.
- Some let you press a button if you feel symptoms.
- Others are always “listening” and start recording automatically if they detect an unusual rhythm.
- There are two main styles:
- Looping event monitors: These keep a short memory “loop” of your heart’s activity. If you activate it, it saves a bit of what happened before you felt the symptom and a bit of what happens after. Clever, right?
- Non-looping event monitors: These just record for a set time after you activate them. Sometimes, with these, you can even take the electrodes off and just put them on quickly when you feel something.
- Real-Time Monitors: These are a bit like event monitors, but they can send the heart activity data straight to a monitoring center. This is really helpful if we’re concerned about more serious arrhythmias where we might need to act quickly. Some can send data automatically, or you can trigger it. There are even types you use during a phone call check-in.
Then there are a couple of other nifty options:
- Patch Recorders: These are super discreet. They’re like a large adhesive patch that sticks right onto your skin, and all the tech is built in. You can wear one for up to two weeks, often without it being very noticeable.
- Implantable Loop Recorders (ILRs): Now, these are for longer-term detective work. An ILR is a tiny device, smaller than a thumb drive, that a specialist can place just under the skin on your chest. It can monitor your heart for up to two or even three years! It records automatically or when you use a small activator. The data is then downloaded wirelessly in the clinic. A big plus is you don’t have to worry about it when you bathe or swim.
Getting Ready for Your Ambulatory Monitor Test
If we decide an ambulatory monitor is the way to go, a specialist, often a cardiologist (a heart doctor) or an electrophysiologist (a heart rhythm specialist), will chat with you about which type is best. We’ll consider your symptoms, your lifestyle, everything.
What do you need to do to prepare? Not too much!
- It’s a good idea to shower or bathe before your appointment to get the monitor fitted, as you might not be able to for a day or two with some types.
- Make sure the skin on your chest is clean and dry. Please don’t use any oils, lotions, or creams on your chest that day. These can make it hard for the electrodes to stick properly or get a good reading.
- Wear a shirt that’s easy to take off and put back on. Something with buttons down the front is perfect.
When you come in, a technician or nurse will explain exactly how to use the device. They’ll show you how it works, and if it’s a type where you need to manage the electrodes, they’ll teach you how to take them off and put them back on (for showering, for example, if allowed). They’ll clean the areas on your chest with a bit of alcohol and might need to shave a little hair to make sure the electrodes have good contact. Then, they’ll stick them on. You’ll also get a list of things to avoid, like strong magnets or certain electronics, that could interfere with the monitor.
Living with the Monitor: What to Expect
Honestly, these tests are usually very straightforward and painless. Your main job is just to wear the monitor as instructed and go about your usual routine as much as possible. Some monitors might ask you to keep a diary of your activities and any symptoms you feel. It helps us match up what your heart was doing with what you were doing.
Once the monitoring period is over – whether it’s a day, a week, or longer – you’ll return the device (unless it’s an implantable one, of course). If you had external electrodes, you just peel them off. Sometimes the adhesive can leave your skin a little red or itchy for a few days. If that happens, let us know; we can suggest ways to soothe it.
Are there risks? For most external monitors, that slight skin irritation is the main thing. If you know you have sensitive skin or allergies to adhesives, please tell us beforehand!
With implantable loop recorders, since it’s a small procedure to place them, there are a few other things, though they’re uncommon:
- You might have a little irritation or soreness where the device was put in. This usually gets better on its own.
- Very rarely, an infection can happen at the site. We’d treat this with antibiotics, but sometimes the device might need to be moved.
- An allergic reaction to the material in the ILR is also rare. If this happens, the device would need to be removed.
- Sometimes, the ILR might have trouble getting a clear signal, and it might need to be repositioned.
Understanding Your Results and Next Steps
After you return the monitor (or come in for a data download from an ILR), the technicians will get all that recorded information. Then, a specialist physician, like a cardiologist or an electrophysiologist, will carefully review it. This is where their expertise really shines, as they look for those patterns that tell us what’s going on.
Once they’ve analyzed everything, we’ll get in touch. This might be a phone call or a follow-up appointment. We’ll explain what the ambulatory monitor showed us and discuss what the next steps should be. Sometimes the monitor gives us a clear diagnosis, and other times it helps us rule things out or points us towards other tests.
When should you call us during the monitoring? Your clinic will give you specific instructions and often a number to call if you have trouble with the device itself.
If you have an implantable loop recorder, definitely call your doctor’s office if you notice any signs of infection like:
- Fever or chills
- The area around the incision feels warm or hot to the touch
- Swelling or redness around the incision
- Any drainage or bleeding from the incision
How long until you get results? It varies. It depends on the type of monitor, how long you wore it, and how busy the clinic is. It’s always okay to ask when you might expect to hear back.
Key Things to Remember About Ambulatory Monitors
Here’s a quick rundown of what we’ve talked about:
- Ambulatory monitors are portable devices that record your heart’s electrical activity over time, helping us diagnose arrhythmias (irregular heartbeats).
- They’re super useful for catching heart issues that don’t show up on a standard in-office EKG.
- There are different types, from short-term Holter monitors and patch recorders to long-term implantable loop recorders. We pick the best one for you.
- Preparation is simple: clean skin, no lotions on your chest, and comfy clothes for your fitting.
- Wearing the monitor is generally easy. You just live your life!
- After the test, a specialist reviews the data, and we’ll discuss the findings and next steps with you. These ambulatory monitors give us incredibly valuable insights.
It can feel a bit strange wearing a medical device, I get that. But these monitors are such helpful tools for us to understand what your heart is truly up to. We’ll walk through it all together.
You’re not alone in this.
