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BASIC & Review of CASE
HOLTER & 24hr BP MONITORING
Seoul St.Marys Hospital Cardiovascular Center
RN. Hyun - Sil IM.
HOLTER MONITORING
READ ECG
24hr BP MONITORING
Review of Case
CONTENTS
1
2
3
4
1. HOLTER MONITORING
HOLTER MONITOR
Norman J. Holter 1961
HOLTER MONITOR
24
.
Indication 1
(AHA/ACC Guideline)
Class I
1.,
2.
Class IIb
1. ,
2.
3. , ,,
Class III
1., , ,
2.
Indication 2
Class I
Class IIb
1.(
Indication 3
(HRV)
Class I
Class IIb
1. (
Indication 4
Class I
Class IIa
Class II
1.
2.
Class III
Indication 5
PACEMAKER ICD
Class I
1. Pacemaker ICD
2. ,
3. ICD
Class IIb
1. Pacemaker ICD
2.ICD
Class III
1. , Pacemaker ICD
2.
Indication 6
Class I
Class IIa
Class IIb
1.
2.
3.
Class III
1.
2.
Test Method
tape , .
Hookup
Require Attention
,
,
2. Read ECG
How to Read EKG (HOLTER)
EKG
Read
Rate
Rhythm
P & QRS
wave
T & U
wave
PR & QT
interval
ST
segment
Arrhythmia Analysis Step 1
Fibrillation wave ? (f)
Flutter wave ? (F)
Nonsinus P ?
Sinus P ?
P wave marking
Arrhythmia Analysis Step 2
QRS marking
Conduction disturbance?
Aberrancy?
WPW syndrome?
Ventricular ectopy?
Ventricular pacing?
Wide bizarre
Normal Configuration
OR
Arrhythmia Analysis Step 3
premature beat, escape beat
QRS P
PR interval
P QRS
Arrhythmia Analysis Step 4
1 ~ 3 P QRS
Normal rate & regular rhythm
Rapid & regular rhythm
Slow & regular rhythm
Irregularly irregular rhythm
Grouped beat d/t pause or block
Grouped beat d/t premature beat
HOLTER MONITOR ANALISIS
1.
2. Artifact
1) (AC interference)
2) (somatic muscle tremor)
3) (wandering baseline)
Impresario
HOLTER MONITOR Report
HOLTER Heart Rate Variability(HRV)
S-A node
(R-R )
,
.
EVENT RECORDER
60~2
-
- :
EVENT RECORDER Report
3. 24hr BP Monitor
24hr Ambulatory BP Monitor(ABPM)
Indication
White coat HTN
Masked HTN( )
Labile HTN( )
Nocturnal HTN( )
(non-dipper)
White coat HTN
- 135/85mmHg
- 140/90mmHg
10~20%
more common
Masked HTN( )
, ABPM HTN
10%
5 2.28
Labile HTN( )
, ,
,
stress
Nocturnal HTN( )
(night time fall)
Night time fall
Dipper or Non-dipper
BP dipper
Fall dip , ABPM
LBBB
Dip
20% Extreme Dipper
ABPM for Hypertension
24 135/85mmHg
140/90mmHg
125/75mmHg
- Borderline 140/90mmHg
- Mild : 155/100mmHg
- Moderate : 170/110mmHg
- Severe :
ABPM
( , ,
)
10% dipper
10% non-dipper
(, , risk 3 )
ABPM
24
12 15 , 12~ 8 30
ABPM REPORTS
ABPM REPORTS
4. Review of Case
Palpitation
Chief Complaint
2-3 intermittent palpitation
2-3 3-5
palpitation, dizziness (
) holter VT
Present illness
Past History
- DM(-) / HBP(-) / TB(-) / Hepatitis(-)
Social History : never smoker
Family History : (-)
History
CASE 1 F / 31
CASE 1
CASE 1
CASE 1
1. RSR : average HR 82 BPM
2. V tach* 2 : 203 beats at 20:18 OM1, 148 beats at 19:21 PM1
3. Pts symtoms(dizzeness, dyspnea, palpatation) was related to
V tach
HUT : positive, mixed type
EP study
Result
F / 60
Syncope
Chief Complaint
underlying disease syncope(chest
discomport,palpitation dizziness syncope)
MRI, MRA acute lesion cardiogenic syncope ER
,
. holter apply .
Present illness
Past History
- DM(-) / HBP(-) / TB(-) / Hepatitis(-)
Social History : smoking denied
Family History : (-)
History
CASE 2
CASE 2
CASE 2
CASE 2
CASE 2
1. RSR with rare APCs(*51, couplets*3)
2. Second degree AV block(mobitz type I&II) & high degree AV
block
3. Pause *36 : longest 12.81 sec at 15:36 PM1
4. ST segment : no change
Pacemaker insertion
Result