[tgokh]

A Holter is essentially an EKG that's left on for a longer period of time. If a patient is coming in with chest pain and your want to evaluate for a heart attack, you really just need a single EKG (and ideally, an older EKG to compare to) to look for the characteristic EKG changes, and blood work to look for signs of damage to the heart muscle. It's really an instantaneous yes/no decision since if the answer is yes, you're likely going to the cath lab or the operating room within minutes (we're often judged on our "door to balloon time", meaning the time from the patient entering the ER to the time the stent is deployed in the heart)

There are other heart conditions that manifest intermittently for which a Holter can help diagnosis. There are a few companies out there working on innovative approaches to make the Holter less cumbersome -- I think iRhythm's ZIO patch was the first on the market and there's several more now. There also some interesting evidence that more subtle signs in the EKG or even unrecognizable-to-humans features of the electrical signal can help proactively predict heart attacks before they happen, but I think that's not yet validated or ready for clinical use. If those type of metrics/analyses prove useful, you could make a case for using Holter-type monitoring to identify a heart attack before it happens

[darkerside]

Thanks for the response. Interesting stuff. Time will come when people look back and have trouble believing we lived without this stuff (like lacking antibiotics, knowledge of hygiene, etc.).