We may recommend the use of a Holter monitor to help diagnose or monitor certain heart conditions, particularly those affecting the heart rhythm. You may be wondering, “Why would I need a Holter monitor?” In this post, we will explain what a Holter monitor is, how it works, and why it is important for your care.

A Holter monitor is a small, portable device that continuously records your heart's electrical activity for 24 to 48 hours. It is similar to an electrocardiogram (ECG) but can record a longer period of time. The device consists of small electrodes that are attached to your chest and connected to a recording device, which can be worn on a belt or shoulder strap.

Holter monitors are used to diagnose and monitor heart conditions, such as arrhythmias, which are abnormal heart rhythms. These conditions may not be detected during a routine ECG or office visit, as they may occur intermittently. They can occur overnight, when you are asleep, and you may not be aware that they occur. A Holter monitor can capture any episodes of abnormal heart rhythms, which can help your cardiologist make an accurate diagnosis and develop a treatment plan.

A Holter monitor can also help your cardiologist evaluate the effectiveness of your treatments. For example, if you are taking medication for an arrhythmia, the Holter monitor can show whether the medication is controlling the abnormal rhythm or whether a change in medication or dosage is necessary.

The holter may be applied in our rooms, in a pathology practice, or even at a radiology / medical imaging practice. Once it is applied, you should go about your normal day. It is often useful to see the heart response to work, rest, stress, etc.

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A patient wearing a holter monitoring system

In summary, a Holter monitor is an important tool for diagnosing and monitoring certain heart conditions. The test is safe and painless.

If you have any further questions about Holter monitoring or your heart health, please do not hesitate to contact us

There are certain types of patients who cannot have an MRI scan (or may only have one with special preparation)s, due to safety concerns or technical limitations. These include:

1. Patients with pacemakers or other implanted electronic devices. The strong magnetic field of an MRI machine can interfere with these devices. This is often more prominent with stronger magnets (3 Tesla) than weaker magnets (1.5T). In the worst case scenario, this may cause harm to the patient. In some cases, patients with these devices may still be able to undergo an MRI scan with special precautions, but it will depend on the specific type of device, the type od scan required, the staff available and the MRI machine used.

2. Patients with loose metal in their body (particularly iron in the eyes): Patients with previous eye damage from metal or iron, such as can occur in welding or shot-blasting, may require eye X-rays before undergoing MRI. The metal can move during the scan and cause damage to the retina.

3. Patients with certain types of metal implants: Some metal implants, such as those made of iron or steel, can heat up, or move, inside the body during an MRI scan, causing tissue damage or other complications. Patients with these types of implants may need to avoid MRI scans or undergo alternative imaging tests. Joint replacements, cardiac stents, and most cardiac valve replacements are usually safe, because the metal is well anchored, but it is important to mention any implants to the radiographers before entering the scan room.

4. Patients with severe kidney problems / dialysis: Some MRI contrast agents can be harmful to patients with severely impaired kidney function. In these cases, doctors may need to use a different type of contrast agent or avoid using contrast altogether.

It's important to inform your doctor about any medical conditions, implanted devices, or pregnancy before undergoing an MRI scan to ensure your safety and the best possible imaging results.

Although medications are often the cornerstone of reducing cardiac risk, maintaining a healthy diet is an important part of maintaining heart health. Minimising processed food seems important. Eating a diet that is high in fruits, vegetables, whole grains, lean proteins, and healthy fats may help reduce the risk of heart disease, stroke, and other cardiovascular conditions.

The South Beach Diet and the Mediterranean diet are two popular eating patterns that have been shown to be beneficial for heart health. Both diets emphasize whole, unprocessed foods and encourage the consumption of healthy fats, lean proteins, and a variety of fruits and vegetables. In this blog post, we'll explore the South Beach Diet and the Mediterranean diet in greater detail and discuss their potential benefits for heart health

The South Beach Diet

Invented by Arthur Agatston

The South Beach Diet is a popular low-carbohydrate diet that was created by cardiologist Dr. Arthur Agatston, who also invented the Agatston score used in CT calcium scoring. Here's a summary of the diet:

• Phase 1: In the first phase, which lasts for two weeks, carbohydrates are limited to 20 grams per day. This phase is designed to kick-start weight loss and help stabilize blood sugar levels. During this phase, dieters eat lean proteins, non-starchy vegetables, nuts, and low-fat dairy products.

• Phase 2: In the second phase, which lasts until the desired weight loss is achieved, carbohydrates are gradually reintroduced into the diet. This phase emphasizes whole grains, fruits, and starchy vegetables. The goal is to find the individual's carbohydrate tolerance level while continuing to lose weight.

• Phase 3: In the third phase, which is the maintenance phase, dieters continue to follow the healthy eating habits they learned in the first two phases. The goal is to maintain the desired weight loss while enjoying a balanced diet that includes all food groups in moderation.

The South Beach Diet also encourages dieters to eat healthy fats, such as olive oil and avocado, and to avoid processed foods and sugary drinks. The diet emphasizes lean proteins, healthy fats, and low glycemic-index carbohydrates. It has been shown to be effective for weight loss, reducing inflammation, improving cholesterol levels, and reducing the risk of heart disease and diabetes.

The Mediterranean Diet

The Mediterranean diet is a heart-healthy eating pattern that is rich in fruits, vegetables, whole grains, legumes, nuts, seeds, and healthy fats, such as olive oil and fatty fish. Here's a summary of the Mediterranean diet for cardiovascular benefits:

• Emphasis on plant-based foods: The Mediterranean diet places a strong emphasis on consuming plant-based foods, such as fruits, vegetables, whole grains, legumes, nuts, and seeds. These foods are high in fiber, vitamins, and minerals that can reduce inflammation and improve heart health.

• Healthy fats: The diet includes healthy fats, such as olive oil, nuts, seeds, and fatty fish. These healthy fats are beneficial for cardiovascular health because they can help reduce inflammation and lower cholesterol levels.

• Limited red meat: Red meat is limited on the Mediterranean diet, and is replaced with lean protein sources, such as fish, poultry, and plant-based proteins like beans and lentils. The red meat consumed in the original studies of this diet was lean, gamey meat, such as rabbit and goat, rather than beef, lamb, or pork. Proponents of this diet suggest that reducing the intake of red meat can reduce the risk of heart disease.

• Moderate alcohol intake: The Mediterranean diet also includes moderate alcohol intake, usually in the form of red wine. However, it's important to note that excessive alcohol intake can have negative health effects, so moderation is key.

• Reducing processed foods: The Mediterranean diet emphasizes consuming whole, unprocessed foods, and reducing the intake of processed and sugary foods. This can improve heart health by reducing inflammation and maintaining healthy blood sugar levels.

Overall, the Mediterranean diet is a healthy eating pattern that can promote heart health by reducing inflammation, improving cholesterol levels, and maintaining healthy blood sugar levels. It is associated with a lower risk of heart disease, stroke, and type 2 diabetes

Echocardiogram (Cardiac Ultrasound)

An echocardiogram, also known as a cardiac ultrasound, is a non-invasive test that allows doctors to assess the structure and function of the heart. The test uses high-frequency sound waves to create detailed images of the heart and its surrounding blood vessels, and is similar to the scans used during pregnancy.

What can I expect:

During an echocardiogram, you will be asked to lie down on a table while the sonographer applies a special gel to your chest and presses (often quite firmly) with an echo probe (see below). This gel helps the sound waves travel more easily and produces clearer images of the heart. You will usually be required to remove clothing from the upper part of the body for this test. Hospital gowns and sheets are available to maintain modesty.

The sonographer places a small device called a transducer, or echo probe, on your chest. The transducer sends out sound waves and picks up the echoes that bounce back from the heart. These echoes are then converted into images that can be seen on a screen.

The sonographer may ask you to change positions or hold your breath during the test to obtain different views of the heart. The test usually takes about 30 - 45 minutes to complete.

Why it's Done:

An echocardiogram can help diagnose or evaluate a variety of heart conditions, including:

• Heart valve disease, such as leaky or narrowed valves

• An enlarged heart (dilated cardiomyopathy)

• Heart failure

• Congenital heart defects

• Increased wall thickness (from hypertensive heart disease or hypertrophic cardiomyopathy)

• Problems with the systolic function (pumping) or diastolic function (relaxing) of the heart's muscle

• Evaluate a dilated aortic root or ascending aorta

Risks:

Echocardiograms are considered very safe and do not involve any radiation exposure. The test is non-invasive and does not require any incisions or injections. The gel applied to your chest may feel cold or sticky, but it is not harmful. The sonographer may need to press firmly, which can be uncomfortable.

After the Test:

Once the echocardiogram is complete, you will be able to resume your normal activities straight away. The results of the scan are often available soon after the test and your cardiologist will review the images and discuss the results with you. This may be on the day of the scan or at a follow-up appointment. In some cases, you may receive a letter detailing the results and follow up. Additional testing or treatment may be recommended based on the results of the test.

Conclusions:

An echocardiogram is a valuable and safe diagnostic tool that can help doctors assess the structure and function of the heart muscle, valves and nearby structures. The test is non-invasive and relatively quick, making it a convenient option for many patients.

If you have any questions or concerns about the test, please don’t hesitate to call the rooms.

Why should I measure my BP at home?

Home blood pressure (BP) monitoring is the self-measurement of BP in the your usual environment, at home, at work or in-between. This provides a number of BP readings that are more reliable for assessment of true underlying BP than a single measurement obtained in the clinic. The readings can be taken on multiple days, and therefore this is complementary to 24-hour ambulatory BP, and is likely to be better for the diagnosis and management high or low blood pressure.

What type of device should I use?

The BP measurement device should use an appropriately sized arm cuff, rather than a wrist cuff, and ideally should be validated and automated. I have written a seperate article about choosing a BP cuff that is also available on this website here.

When should I check my BP?

There are different schools of thought on how best to assess home BP.

For many patients, I will ask that you assess the BP randomly throughout the day. Check at breakfast time one day, then dinner time the next. This gives an estimate of BP control at different times throughout the day, and mimics a 24 hour BP monitor test.

However the official guidelines suggest a more standardised approach.

Heart Foundation Guidelines on Home BP Assessment

How should I check my BP?

The Heart Foundation advice is that a patient should measure their BP at around the same time in the morning and the evening, before medication over a period of seven days. BP should be checked after going to the toilet but before food, caffeine or vigorous exercise, as all these can affect BP.

In order to achieve “standard” measurements, it is suggested that two BP measurements should be taken in a quiet room after five minutes of seated rest with feet on the floor, and the two readings taken one minute apart. The actual advice is as follows, “The patient should be in the seated position with feet flat on the floor, legs uncrossed, upper arm bare, back supported and arm supported in a relaxed position with the cuff at heart level”. The BP should be recorded immediately in a diary.

It is worth noting that late morning / lunch-time readings may also provide information for optimising the timing of medications (for example morning versus evening), and so I often ask for these too. If necessary, a formal 24-hour ambulatory BP monitor can provide further information where necessary.

This process (the sitting down in a standard position within a quiet room) ensures that we are recording the lowest possible BP, in a reproducible manner. If following this approach, the readings could be recorded in a home BP diary, such as the downloadable one below.

Download a printable pdf version here.

Down load a spreadsheet version (which automatically calculates average values) here.

Do I need my own blood pressure monitor?

High blood pressure (BP), or hypertension, is one of the major risk factors for atherosclerosis and can independently lead to stroke. High blood pressure is especially dangerous because it may not cause any symptoms, and the only way to know that you have hypertension is to check your blood pressure.

Optimal control means having a blood pressure that is within the normal range most of the time, without having many abnormally high or low values. Rather than simply taking one BP reading in the clinic, and using this as the basis for treatment decisions, it is better to obtain numerous readings from a persons normal environment.

Therefore a home blood pressure machine (along with a notebook to record the results) is a valuable tool in managing cardiovascular risk. Many machines are available over the internet or from local chemists. It can be difficult to know which one to choose.

The British and Irish Hypertension Society publish a list of validated BP monitors. This means BP machines that have been assessed independently and proved to give accurate readings. While some of these brands are not available in the Australian market, there is considerable overlap. However the model names vary between markets. The list can be found here.

To simply the process we often recommend the Omron brand. Omron are a reputable manufacturer that sell machines in both the UK and Australia and all their machines are clinically validated. Their Australian model range and a comparison tool can be found here. It is important to choose an arm cuff, rather than a wrist cuff. The arm cuff should be an appropriate size, as being too large or too small will distort the assessment.

Wrist BP Monitoring Devices

Wrist devices are not accurate enough in routine home use. They are more likely to have errors in BP assessment than the standard upper arm BP monitors. Although some wrist devices might meet accuracy criteria if strict attention is paid to having the wrist perfectly at heart level, this can be difficult to achieve reproducibly in normal home use. Standard, validated upper arm BP monitors are recommended in preference to wrist devices.