CET Holter Monitoring and Ambulatory EKG 2 — Questions and Answers
Question 1: Which lead configuration is most commonly used in two-channel Holter monitoring?
- Leads I and aVF
- Modified bipolar leads resembling V1 and V5 positions (e.g., CM5 and CC5) (Correct answer)
- Leads II and III
- aVR and aVL
Correct answer: Modified bipolar leads resembling V1 and V5 positions (e.g., CM5 and CC5)
Modified bipolar leads resembling V1 and V5 positions are most commonly used because they provide effective arrhythmia detection and ST segment monitoring.
Question 2: A cardiac event monitor differs from a standard Holter monitor in that it:
- Records continuously for only 24 hours
- Requires hospital-based monitoring at all times
- Can be worn for weeks to months and records during symptomatic episodes (Correct answer)
- Uses permanently implanted leads
Correct answer: Can be worn for weeks to months and records during symptomatic episodes
Unlike a Holter that records continuously for 24-48 hours, a cardiac event monitor is worn for weeks to months and records when triggered by patient symptoms or automatic arrhythmia detection.
Question 3: After Holter monitoring is complete and the patient returns the device, what should the technician do FIRST?
- Immediately download and print the final report
- Inspect electrode sites for skin irritation and document findings (Correct answer)
- Recharge the device battery for the next patient
- Send the patient home without any further assessment
Correct answer: Inspect electrode sites for skin irritation and document findings
Patient safety comes first; the technician should inspect and document any skin reactions or breakdown at electrode sites before downloading data.
Question 4: For which condition would Holter monitoring be MOST clinically useful?
- Chronic stable hypertension
- Pulmonary embolism
- Paroxysmal supraventricular tachycardia (PSVT) (Correct answer)
- Osteoarthritis with joint pain
Correct answer: Paroxysmal supraventricular tachycardia (PSVT)
PSVT is ideal for Holter evaluation because it occurs unpredictably and briefly, requiring extended monitoring to capture the arrhythmia during a symptomatic episode.
Question 5: Heart rate variability (HRV) analysis from a Holter recording provides information primarily about:
- Coronary artery stenosis severity
- Pulmonary artery pressure
- Left ventricular ejection fraction
- Autonomic nervous system function and cardiovascular risk (Correct answer)
Correct answer: Autonomic nervous system function and cardiovascular risk
HRV analysis measures the variation in time between consecutive heartbeats, which reflects autonomic nervous system tone and is a predictor of cardiovascular risk.
Question 6: During Holter electrode placement, which location should be AVOIDED?
- Areas with minimal body hair
- The left lateral chest wall
- Bony prominences and areas with excessive motion (Correct answer)
- Areas near the cardiac apex
Correct answer: Bony prominences and areas with excessive motion
Bony prominences and high-motion areas should be avoided because they increase artifact and impair electrode adhesion during activity.
Question 7: A patient wearing a Holter monitor should be instructed to:
- Remove the device before sleeping each night
- Avoid all physical activity for the entire recording period
- Continue normal daily activities while maintaining an accurate diary (Correct answer)
- Bathe normally since all Holter devices are fully waterproof
Correct answer: Continue normal daily activities while maintaining an accurate diary
Patients should continue normal activities so the recording reflects everyday cardiac behavior, while documenting symptoms and activities in the diary for physician correlation.
CET Holter Monitoring and Ambulatory EKG 2
Which lead configuration is most commonly used in two-channel Holter monitoring?