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AMBULATORY  ECG  MONITORING  
 
They  can  be  a  continuous  recording  of  every  heart  beat  the  patient  has  over  the  24/48/5-­‐
day  period  the  patient  is  wearing  the  monitor  or  they  can  be  symptomatic  event  recordings
...
Continuous  recording  devices  –  LIFECARD    
2
...
Patient  activated  recorders  –  CARDIO  MEMO  
Device  the  patient  carries  with  them,  when  they  are  symptomatic  they  can  apply  the  
monitor  to  their  chest  and  take  a  recording
...
   
 
WHY?  
They  are  used  to  evaluate  cardiac  activity  while  patient  is  in  their  own  environment  and  
mobile
...
 
3  electrodes  used,  3  channels  for  <48  hours,  2  channels  for  >48  hours
...
 This  could  leave  
residual  noise  on  the  tape
...
   
 
INDICATIONS:    
• Syncope  
• Dizziness  
• Palpitations    
• Find  potential  cause  of  cerebrovascular  event  e
...
 TIA,  ?  PAF  as  cause  
• Episodic  chest  pain/  SOB/  fatigue  with  no  obvious  cause  
• Suspected  arrhythmias    
• Assess  effectiveness  of  medications/  ablation/  pacemaker/  ICD  function  
• ST  segment  analysis  ?ischaemia/  angina    
(ST  segment  analysis  is  not  routinely  used  as  the  leads  are  unconventional  and  it  
depends  greatly  on  electrode  positioning
...
Patient  compliance    
2
...
 If  
they  do  you  could  use  hypoallergenic  
electrodes
...
 If  the  patient  
has  a  hairy  chest  you  may  need  to  shave  a  patch  into  it  to  get  good  contact  with  the  skin
...
 This  
reduces  impedance  and  gives  a  clear,  better  quality  recording
...
   
Then  position  the  electrodes  onto  the  patient’s  skin  by  pressing  down  firmly  on  the  outer  
sticky  edges,  do  not  press  the  middle  of  the  electrode  where  the  gel  is  as  the  gel  can  burst  
giving  a  less  clear  ECG  recording
...
   
 
PATIENT  INSTRUCTIONS    
Instructions  must  be  clear  and  concise  so  that  the  patient  understands  what  they  have  to  
do
...
   
Do  not  get  the  monitor  wet
...
   
Explain  the  diary  card
...
The  patients  must  return  the  diary  card  even  if  they  experience  no  symptoms,  if  
they  don’t  have  any  symptoms  they  don’t  have  to  write  anything
...
 
The  monitor  may  beep  if  one  of  the  leads  falls  off,  just  reconnect  the  lead  and  the  beeping  
should  stop
...
   
Emphasise  monitor  needs  to  be  returned  promptly  so  that  other  patients  can  use  it  and  it  
will  mean  they  will  get  their  results  back  more  quickly
...
 The  leaflet  will  also  have  the  
departments  phone  number  on  it  so  they  can  ring  it  if  they  have  any  problems
...
 It  only  stores  patient  events  and  things  it  “thinks”  are  of  
significance  such  as  arrhythmias
...
 
 
Patient  can  activate  the  recorder  when  they  are  
symptomatic
...
   
 
There  are  2  electrodes  used  for  an  R  test    
1
...
V5  position,  can  also  be  placed  on  the  back  of  
the  neck  
 
This  produces  1  channel  for  analysis
...
 
Difficult  to  determine  the  frequency  and  length  of  arrhythmia  as  it  only  displays  what  it  
deems  to  be  the  “most  important”  strips
...
   
Patient  should  be  warned  that  it  will  alarm  when  a  lead  is  disconnected
...
   
 
CARDIO  CALL/  CARDIO  MEMO:  
Patient  activated  monitor  therefore  the  patient  must  be  compliant  to  use  it
...
 This  is  not  recommended  for  patients  with  
Dementia,  Parkinson’s  disease  or  syncope
...
   
 
The  monitor  has  to  be  placed  flat  on  the  patient’s  
chest  ensuring  good  skin  contact  and  then  press  the  
record  button
...
 The  patient  must  ring  the  designated  
number  from  a  landline
...
 They  will  be  asked  their  name,  recorder  number  and  

symptoms/activity  at  the  time
...
   
 
 



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