CVT Holter & Ambulatory Monitoring 2 — Questions and Answers
Question 1: A patient returns a Holter monitor with significant baseline wander throughout the recording. What is the MOST likely cause?
- Loose or poorly prepared electrode sites (Correct answer)
- Low battery in the recorder
- Incorrect lead placement order
- Patient sleeping on the recorder
Correct answer: Loose or poorly prepared electrode sites
Baseline wander is most commonly caused by poor electrode-skin contact due to inadequate skin preparation or loose electrodes.
Question 2: During Holter analysis, you identify a pause of 2.8 seconds occurring at night during sleep. What is the most appropriate next step?
- Flag as a critical finding requiring immediate physician notification (Correct answer)
- Discard as artifact since it occurred during sleep
- Note it as a normal variant of sinus arrhythmia
- Repeat the Holter to confirm the finding
Correct answer: Flag as a critical finding requiring immediate physician notification
Pauses greater than 2.5 seconds are clinically significant and should be flagged for physician review regardless of when they occur.
Question 3: Which Holter lead configuration is considered most useful for detecting ST-segment changes associated with ischemia?
- CM5 and CC5 (Correct answer)
- Lead I and aVL
- V1 and V2
- Lead II and III
Correct answer: CM5 and CC5
CM5 monitors the lateral wall and CC5 monitors the inferior-lateral wall, providing the best sensitivity for ischemic ST changes in ambulatory monitoring.
Question 4: A 24-hour Holter recording shows 12,000 premature ventricular contractions (PVCs). How should this finding be expressed in the report?
- As both total count and percentage of total beats (Correct answer)
- As total count only
- As frequency per hour only
- As beats per minute only
Correct answer: As both total count and percentage of total beats
PVC burden is most completely expressed as total count and percentage of total beats, which gives the physician the clearest picture of ectopic burden.
Question 5: When applying Holter electrodes to a patient with extremely diaphoretic skin, which preparation technique is MOST important?
- Thorough drying and antiperspirant application before electrode placement (Correct answer)
- Using extra adhesive tape over the electrodes
- Placing electrodes on bony prominences for stability
- Increasing the number of electrode sites
Correct answer: Thorough drying and antiperspirant application before electrode placement
Drying the skin thoroughly and applying antiperspirant helps reduce sweating that causes electrode lift and signal loss.
Question 6: A patient's event diary notes 'palpitations at 2:15 PM' but the Holter tracing shows normal sinus rhythm at that time. What is the BEST interpretation?
- The palpitations may be non-cardiac in origin or represent a perception disorder (Correct answer)
- The Holter recorder malfunctioned at that time
- The diary time was incorrectly entered into the recorder
- The patient experienced a brief arrhythmia that self-terminated
Correct answer: The palpitations may be non-cardiac in origin or represent a perception disorder
When a patient reports symptoms but the concurrent ECG is normal, the symptoms may be non-cardiac or represent heightened cardiac awareness without true arrhythmia.
Question 7: What does the term 'couplet' mean in Holter monitoring terminology?
- Two consecutive premature ventricular contractions (Correct answer)
- A pair of P waves before each QRS
- Two consecutive supraventricular beats
- A bigeminal pattern lasting two cycles
Correct answer: Two consecutive premature ventricular contractions
A couplet refers to two consecutive PVCs occurring back-to-back, which is more concerning than isolated PVCs.
CVT Holter & Ambulatory Monitoring 2
A patient returns a Holter monitor with significant baseline wander throughout the recording.
What is the MOST likely cause?