holter monitoring

7/24/2019 Holter Monitoring

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HOLTERDAN

PEMBACAANNYA

BRAGHMANDARU AB


2/20

Holter Monitor :

Alat pemantauan aktivitas listrik 24 jam,menilai: irama jantung dan evaluasi terapipada pemasangan pacemaker.

Menggunakan elektroda yg dipasangkan didada, dihubungkan ke alat penyimpaninformasi aktivitas listrik selama perekaman

PENDAHULUAN


3/20

!M"!#$#%&

hest electrodes "atients diary 'ecording

apparatus Holter monitor

scanner

PENDAHULUAN


4/20

PENDAHULUAN


5/20

AMBULATORY EKG

(ilakukan 24 ) 4* jam$+ 2 ) - channel

"asien menjalankan akti tas rutin

/a0a buku catatan keluhan catat setiap kejadian

sesuai jam 1pusing, debar debar3

MOBILE CARDIAC OUTPATIENT TELEMETRY (ilakukan beberapa hari ellular based transmission system

Episodic (event) Monitorin aktu tak terbatas Hanya merekam kalau perlu"erekaman oleh pasien

(ikirim ke '& melalui telephone

PENDAHULUAN


6/20

PENDAHULUAN


7/20

PENDAHULUAN


8/20

PENDAHULUAN


9/20

INDIKASI

AHA GUIDELINE AMBULATORY ECG 1999

(iagnosis gejala yg mungkin berhubungan dengangangguan ritme jantung

5. "asien dg syncope, near syncope atau episodedi66ines dg penyebab blm jelas 173

2. "asien dg palpitasi rekuren 173-. "asien dg episode &!/, nyeri dada, atau fatigue dg

kausa blm jelas 177/3

4. "asien dg ggn neurologis dg susp kausa dari A8 177/3

9. "asien dg ggn sinkope, near syncope, di66ines danpalpitasi tdk respon dg t dr kausa selain aritmia177/3;. "asien dg gejala dg penyebab sdh teridenti kasi 17773


10/20

INDIKASI


"rognostik cardiac event pd pasien %A#"A$>A?A

5. "ost M7 dg ?=$8 @ 4 B 177/3

2."asien H8 177/3

-. 7diopatic M 177/34. 777 :

"ost M7 ?= baik, ?= Hipertropi dg hipertensi,$valuasi aritmia pre op non cardiac, "asien=H(, "asien dg sleep apneu


11/20

INDIKASI


$valuasi fungsi 7 ( dan ""M5. $valuasi pd pasien dg gejala untuk

menyingkirkan ggn pacemaker 173

2.$valuasi pd keadaan curiga malfungsi ataufailure device 173

-. Melihat respon terapi pd 7 ( t 1734. $valuasi postoperative "M function 177/3

9. $valuasi kejadian &= aritmia on de b 177/3


12/20

INDIKASI


7skemia5. &usp =ariant Angina 177A32. $valuasi pasien chestpain tdk bs e ercise

177/3

-. +no0n A( 0ith atipical chest pain syndrome177/3


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DIAGNOSTIK

&ensitivitas lebih rendah 1; B3 sbgdiagnostik A( iskemia dibanding $ ercisetest 1 unther et al, 5C**3


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iNTERPRETASi


15/20

H!?%$' $ '$"!'% &DMMA'E Eou also have a demo copy of the Holter $ report.

7t 0ill be easier for you to read. %he rst page is theHolter $ 'eport &ummary.

7t has si 1;3 bo es of data summaries. %he rst bois Heart 'ate data.

%he 2nd bo is for ventricular ectopic 1=$3 beats. =$beats in e cess of 5 per hour, =$ "air, = 'uns, and 'on % beats are 0orrisome.

%he - rd bo is for Heart 'ate =ariability 1H'=3. An&(## of 9 or less is cause for concern.

#e t is &%. (elta &% depressions of 5mm or moreare 0orrisome.

#e t are &=$Fs 1atrial ectopics3. &= 'uns and A 8ibare 0orrisome.

#e t are /radycardia events. "auses in e cess of2.9 seconds are problems. %his is follo0ed by G%summaries. G%c in e cess of 4; ms can lead toproblems.

Mini $ strips give a general impression.2 2- 5;(M &oft0are 59


16/20

24 H!D' %'$#(& '$"!'% %his is the 2 nd page to the basic Holter $ 'eport.

7t sho0s 24 hour trends of Heart 'ate, &%, H'=&(##, H'= "o0er, =$ beats, and &=$ beats.

%he bottom half sho0s the hourly counts for heartrate, arrhythmias, pauses, and &%.

%he top H' graph sho0s the ma avg min H' foreach minute during the 24 hour Holter $ . %he

ma and min H' $ is sho0n to the right.

%he ne t trend is the &% segment. 7f an &% 0asmore than 5mm, the ma &% is sho0n to the right.

%he ne t 2 trends are Heart 'ate =ariability trends. %hey are &(## and %otal "o0er. %he &(##

should be above 9 , and the "o0er should beabove * .

%he ne t 2 trends are =$ and &=$ arrhythmias perhour. =$ beats in e cess of 5 hour, =$ "airs, and= 'uns may 0arrant action. %he same may applyto &= 'uns and A 8ib minutes.2 2- 5;(M &oft0are 5;


17/20

($?%A &% A#A?E&7& &% depressions of 5mm or more are a strong

indication of blockage in the coronary arteries.

%he top left $ sho0s the ma &% depressionduring the 24 hour Holter $ . %he top right$ sho0s the ma G%c during the Holter.

An &% $pisode is 0hen both the > point and &%are depressed by 5mm or more for a timeperiod of 5 minute or longer.

>ust belo0 the $ strips are summaries of &%$pisode events.

%he bottom half sho0s 24 hour trends of Heart'ate, > point level, and &% level for each of the -$ channels.

%he $ Fs to the right sho0 the ma &%elevation, the most common &% level, and thema &% depression.2 2- 5;(M &oft0are 5

holter monitoring

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