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British Heart Journal logoLink to British Heart Journal
. 1980 Oct;44(4):419–425. doi: 10.1136/hrt.44.4.419

Ambulatory ST segment monitoring. Problems, pitfalls, solutions, and clinical application.

V Balasubramanian, A Lahiri, H L Green, F D Stott, E B Raftery
PMCID: PMC482422  PMID: 7426205

Abstract

The introduction of frequency modulated recording systems for ambulatory electrocardiographic monitoring (Oxford Medilog mark 2 and Cardiodyne cassette recorders) prompted comparison with a conventional direct recording type of recorder (Oxford Medilog mark 1). The recordings obtained by the frequency modulated recorders were very much superior to those obtained by the direct recording type of recorder. The direct recording suffered from poor low frequency response, phase shift, and cable motions artefacts. Correction of these problems with careful attention to electrode application enabled stable graphs to be obtained over 24 hours. The clinical applications were explored by comparing the results of exercie tests with a computer assisted system with frequency modulated ambulatory monitoring in 30 patients. A range of ST deviations from pure ST depressions throughout 24 hours, pure ST elevation, and a combination of ST elevation and depression were seen, suggesting a spectrum of changes hitherto unsuspected in these patients. Painless ST changes were approximately twice as common as those associated with pain. These findings indicate a valuable role for ST segment monitoring in ischaemic heart disease, particularly with the availability of high fidelity modulated tracings which do not distort ST segments.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen R. D., Gettes L. S., Phalan C., Avington M. D. Painless ST-segment depression in patients with angina pectoris. Correlation with daily activities and cigarette smoking. Chest. 1976 Apr;69(4):467–473. doi: 10.1378/chest.69.4.467. [DOI] [PubMed] [Google Scholar]
  2. Balasubramanian V., Raftery E. B., Stott F. D. Myocardial ischaemia in patients with frequent angina pectoris. Br Med J. 1979 Jan 20;1(6157):198–198. doi: 10.1136/bmj.1.6157.198-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Berson A. S., Pipberger H. V. The low-frequency response of electrocardiographs, a frequent source of recording errors. Am Heart J. 1966 Jun;71(6):779–789. doi: 10.1016/0002-8703(66)90599-0. [DOI] [PubMed] [Google Scholar]
  4. Bonoris P. E., Greenberg P. S., Christison G. W., Castellanet M. J., Ellestad M. H. Evaluation of R wave amplitude changes versus ST-segment depression in stress testing. Circulation. 1978 May;57(5):904–910. doi: 10.1161/01.cir.57.5.904. [DOI] [PubMed] [Google Scholar]
  5. Harrison D. C., Fitzgerald J. W., Winkle R. A. Ambulatory electrocardiography for diagnosis and treatment of cardiac arrhythmias. N Engl J Med. 1976 Feb 12;294(7):373–380. doi: 10.1056/NEJM197602122940706. [DOI] [PubMed] [Google Scholar]
  6. Hinkle L. E., Jr, Meyer J., Stevens M., Carver S. T. Tape recordings of the ECG of active men. Limitations and advantages of the Holter-Avionics instruments. Circulation. 1967 Nov;36(5):752–765. doi: 10.1161/01.cir.36.5.752. [DOI] [PubMed] [Google Scholar]
  7. Kennedy H. L., Caralis D. G. Ambulatory electrocardiography. A clinical perspective. Ann Intern Med. 1977 Dec;87(6):729–739. doi: 10.7326/0003-4819-87-6-729. [DOI] [PubMed] [Google Scholar]
  8. Selwyn A. P., Fox K., Eves M., Oakley D., Dargie H., Shillingford J. Myocardial ischaemia in patients with frequent angina pectoris. Br Med J. 1978 Dec 9;2(6152):1594–1596. doi: 10.1136/bmj.2.6152.1594. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Stern S., Tzivoni D. Early detection of silent ischaemic heart disease by 24-hour electrocardiographic monitoring of active subjects. Br Heart J. 1974 May;36(5):481–486. doi: 10.1136/hrt.36.5.481. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Stern S., Tzivoni D. The reliability of the Holter-Avionics system in reproducing the ST-T segment. Am Heart J. 1972 Sep;84(3):427–428. doi: 10.1016/0002-8703(72)90382-1. [DOI] [PubMed] [Google Scholar]
  11. Wolf E., Tzivoni D., Stern S. Comparison of exercise tests and 24-hour ambulatory electrocardiographic monitoring in detection of ST-T changes. Br Heart J. 1974 Jan;36(1):90–95. doi: 10.1136/hrt.36.1.90. [DOI] [PMC free article] [PubMed] [Google Scholar]

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