What is a Cardiac Event Monitor?

You have just seen your cardiologist, and she has decided that your heart and its behaviors and functionalities need to be observed by a Cardiac Event Monitor. It sounds a little scary, and you are left wondering just what you’re in for during this examination period. If you’re anything like me, you have asked your cardiologist a host of questions and done some on line searches of your own, and you are discouraged to find that you still don’t have a clear idea of what this monitoring is going to do, and what you are going to experience as you perform it.

I can give you a clear, simply stated, layman’s description of the experience of wearing a Cardiac Event Monitor from a patient’s point of view. Hopefully, you will find your anxieties and confusion lift a bit when you have a little information about this tedious but non-invasive test. Certainly that is my intention.

I left my cardiologist’s office and took my little billing slip up to one of her administrative associates. As instructed, I informed the associate that I needed a Cardiac Event Monitor “with loop” ordered for me. It all sounded very odd. Having already had the experience of wearing a twenty-four hour Holter Monitor (see my earlier article in my on going “What isâÂ?¦” medical procedures simplified series entitled “What is a Holter Monitor?”), I imagined that the phrase “with loop” referred to some sort of strap, handle, or belt for the monitor to be secured to my person with. I was a little off the mark.

The administrative associate informed me that she would take care of everything, and that the Event Monitor would arrive at the door of my home within a week or so, via UPS. Having no personal medical knowledge of such devices, I asked her exactly what I would need to do with this monitor once it arrived. Each of the other tests I had had executed on my ticker thus far had been either performed, or at least attached and turned on, by medical personnel. She assured me that the instructions would be clear, thorough, and easy to follow. I walked away a bit dubious, but willing to give it my all.

Sure enough, four days later, the monitor arrived from a company called “Heartrack”. The instructions were, in fact, clear, thorough, and easy to follow. For anyone who has experienced wearing a Holter Monitor, the basic set up is almost identical, but with only two electrodes to attach instead of five. For the rest of you, the monitor looks like a small, black box, a little smaller that your basic Walkman radio. In the case with the monitor was a set of cords (two of them, one with a white head and one with a black), that come together at one end and plug into the monitor the way a head set plugs into a stereo, and attach to electrodes at the other. Also in the case were six AAA batteries, a strap (ahâÂ?¦ the loop?), and a set of instructions. Also included in the package were two large envelopes full of electrodes.

The instructions included a picture of exactly where to place the electrodes on the torso. One attached to the right clavicle and the other just below the left pectoral muscle. The white headed cord is then to be attached to the right electrode, and the black to the left. So far, so simple. Three of the batteries were then placed into the monitor and the cords were attached to the unit.

Once it was functional, the monitor ran a display that read “SCANNING 1 OF 2”. And then began the dance of living with this thing attached to the center of my chest with a cord hanging down from my shirt getting caught on things, and looking just a little too Bride of Frankenstein-ish.

So what does the Cardiac Event Monitor do, and what do you do with it? The monitor is continuously scanning what your heart is doing. Whenever you feel a symptom, be it a fluttering sensation, palpitation, dizziness, thumping, or anything that makes you aware of your heart in any way, you push a button on the front of the unit labeled “EVENT”. Once pushed, you are encouraged to stay very still and calm, and the monitor will emit a high-pitched sound from a tiny hole on the front of the device for about thirty seconds while it records what your heart is doing at that moment into the device.

This may lead you to ponder the same concern that I first had upon reading the instructions. Cardiac symptoms are generally fleeting experiences, which are over before you can even recognize that it is time to push the event button. How are you ever going to be able to catch an event to record it as it is occurring? Well, that brings us to the explanation of what the “loop” is. As I mentioned, the monitor is continuously scanning what your heart is doing. When you engage the event button to record, the event monitor actually begins recording what was happening thirty seconds before you pressed the button, and continues recording until the sound stops. The best advice I received was that when I felt something occurring in my heart, I should take a breath, center myself in a comfortable position, and then press the button to record.

Once you have recorded an “event”, the display will change to “SCANNING 2 OF 2”. You can record two separate events before you need to transmit them and reset the monitor (I will get into transmitting in a moment). This display is extremely helpful. As the days pass, it is easy to forget how many events you have recorded since your last transmission.

SoâÂ?¦ transmission. It is my experience that we have come into a truly fascinating era in the advancement of medical science, and the transmission of a cardiac event captured by the Cardiac Event Monitor is evidence of that experience. On the back of your monitor is a sticker with a twenty-four hour 1-800 number on it. After recording two events, you call that number and tell the person who answers that you need to “transmit”.

During daytime hours, you will be transferred to the technician who will capture the transmission for you. In the evening and night hours, your call will be answered directly be the tech. You will be asked what your symptoms were for each of the two events (a fluttering feeling, pressure, irregular heartbeat, etc.), which the tech will make a note of and attach them to the record of the event. You will then be instructed to begin transmission.

What happens when you transmit is that you simply unplug the cords from the monitor and set it on a table or flat surface. You then take your telephone headset and set it so that the mouth piece is resting directly on the small hole on the front of the monitor. Press the “EVENT” button and again you will hear a high pitched series of squeals emitting from the device. The sounds are similar to those you heard when capturing each event, but you will note some differences in tones and frequencies, and the transmission of each event takes about four times as long as it took you to capture it. You will be on the telephone for about four minutes, so it is helpful if you can be somewhere that you can so something quietly nearby, or the experience can become more than a little bit tedious.

What is happening as those tones are being emitted into the telephone is impressive. Similar to the way that computers can recognize the tones of a telephone to receive information, the machines at the Cardiac Event Monitor’s command center are reading the tones you are sending over the telephone and turning them into an EKG. The readout of this EKG is available to your cardiologist via computer, so she can check out what is happening with your heart at any time she logs onto the command center’s database. Furthermore, the technicians are trained to recognize any concerning or life threatening data and contact the cardiologist if anything appears to be in need of immediate attention.

Once the Cardiac Event Monitor is through with its transmission it will become quiet again. You will then pick up the telephone and the technician will return to the line and let you know if everything came through all right. If it did, you will be instructed to reset the monitor (by using the pointed end of the cords to depress the button inside a small hole labeled “reset” on the top of your monitor), re-plug the cords, and reattach it to your electrodes so you can begin the experience again. The display on the front of the monitor will return to reading “SCANNING 1 OF 2”. If there was any interference (too much background noise, the telephone not being place properly, etc.) you may be asked to transmit again. Once you have recorded two more events, you simply call back and transmit again. This continues for as long as your cardiologist determines.

And you are all set. Most Cardiac Event Monitor durations last about 30 days, but often the cardiologist just wants to obtain representative data of the symptoms you’ve been experiencing, and you may be able to return the monitor once you have an appropriate data set for her. The return is easy. The monitor will have arrived with a pre-addressed FedEx envelope. You simple gather up all the parts and re-package it all in the case. If you have an unopened envelope of electrodes it is nice to return that as well. The remains of an opened package do not need to be returned, as they can not be used one the seal on the envelope is broken. Place the case into the FedEx envelope, kiss it good bye, and drop it in your nearest FedEx drop box.

Although, as I have stated all ready, I found the use of the Cardiac Event Monitor to be a cumbersome, awkward, tedious experience, and I did not love showing up to work and the gym each day with wires hanging down out of my shirt, I am amazed by what we can do with medical technology these days, and grateful for the information that technology has provided me. The use of the monitor is neither painful nor invasive (the most discomfort I felt was a slight irritation where the electrodes were repeatedly placed). It was a perfectly reasonable experience considering the information that was gained about my funky little ticker.

Good luck!

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