[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"menu":3,"$fPxQnZgUUX8nl6_x80DBQzvE0xjYf9HpbCJ0cuwZiE2w":210},{"main":4,"mainTranslated":17,"footer":45,"footerTranslated":109},[5,8,11,14],{"title":6,"url":7},"Course library","https:\u002F\u002Fwww.medmastery.com\u002Fcourse-library",{"title":9,"url":10},"Pricing","https:\u002F\u002Fwww.medmastery.com\u002Fpricing",{"title":12,"url":13},"Earn credits","https:\u002F\u002Fwww.medmastery.com\u002Fcme-credits",{"title":15,"url":16},"Institutions","https:\u002F\u002Fwww.medmastery.com\u002Finstitutions",{"de":18,"es":27,"fr":36},[19,21,23,25],{"title":20,"url":7},"Kurse",{"title":22,"url":10},"Preise",{"title":24,"url":13},"CME-Punkte",{"title":26,"url":16},"Organisationen",[28,30,32,34],{"title":29,"url":7},"Biblioteca de cursos",{"title":31,"url":10},"Precios",{"title":33,"url":13},"Gana créditos",{"title":35,"url":16},"Instituciones",[37,39,41,43],{"title":38,"url":7},"Cours",{"title":40,"url":10},"Tarifs",{"title":42,"url":13},"Obtenir des crédits",{"title":44,"url":16},"Établissements",[46,59,79,97],{"title":47,"group":48,"menu":49},"Company",true,[50,53,56],{"title":51,"url":52},"Our teachers","https:\u002F\u002Fwww.medmastery.com\u002Fteachers",{"title":54,"url":55},"About us","https:\u002F\u002Fwww.medmastery.com\u002Fabout-us",{"title":57,"url":58},"Work with us","https:\u002F\u002Fwww.medmastery.com\u002Fwork-with-us",{"title":60,"group":48,"menu":61},"Product",[62,64,67,70,73,76,78],{"title":63,"url":7},"Courses",{"title":65,"url":66},"Magazine","https:\u002F\u002Fwww.medmastery.com\u002Fmagazine",{"title":68,"url":69},"Podcast","https:\u002F\u002Fwww.medmastery.com\u002Fpodcasts",{"title":71,"url":72},"Webinars","https:\u002F\u002Fwww.medmastery.com\u002Fwebinars",{"title":74,"url":75},"Guides","https:\u002F\u002Fwww.medmastery.com\u002Fguides",{"title":15,"url":77},"https:\u002F\u002Fwww.medmastery.com\u002Finstitutions\u002F",{"title":9,"url":10},{"title":80,"group":48,"menu":81},"Legal",[82,85,88,91,94],{"title":83,"url":84},"Imprint","https:\u002F\u002Fwww.medmastery.com\u002Fimprint",{"title":86,"url":87},"Newsletter policy","https:\u002F\u002Fwww.medmastery.com\u002Fnewsletter-privacy-policy",{"title":89,"url":90},"Privacy policy","https:\u002F\u002Fwww.medmastery.com\u002Fprivacy-policy",{"title":92,"url":93},"Cookie Policy","https:\u002F\u002Fwww.medmastery.com\u002Fcookie-policy",{"title":95,"url":96},"Terms","https:\u002F\u002Fwww.medmastery.com\u002Fterms",{"title":98,"group":48,"menu":99},"Customer support",[100,103,106],{"title":101,"url":102},"FAQs","https:\u002F\u002Fwww.medmastery.com\u002Ffaqs",{"title":104,"url":105},"Contact","https:\u002F\u002Fwww.medmastery.com\u002Fcontact",{"title":107,"url":108},"support@medmastery.com","mailto:support@medmastery.com",{"de":110,"es":143,"fr":177},[111,118,128,137],{"title":112,"group":48,"menu":113},"Unternehmen",[114,116,117],{"title":115,"url":52},"Unsere Dozentinnen und Dozenten",{"title":54,"url":55},{"title":57,"url":58},{"title":119,"group":48,"menu":120},"Produkt",[121,122,123,124,125,126,127],{"title":20,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":26,"url":77},{"title":22,"url":10},{"title":129,"group":48,"menu":130},"Rechtliches",[131,133,134,135,136],{"title":132,"url":84},"Impressum",{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":138,"group":48,"menu":139},"Kundenservice",[140,141,142],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},[144,151,162,171],{"title":145,"group":48,"menu":146},"Empresa",[147,149,150],{"title":148,"url":52},"Nuestros profesores",{"title":54,"url":55},{"title":57,"url":58},{"title":152,"group":48,"menu":153},"Producto",[154,156,157,158,159,160,161],{"title":155,"url":7},"Cursos",{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":35,"url":77},{"title":31,"url":10},{"title":163,"group":48,"menu":164},"Información legal",[165,167,168,169,170],{"title":166,"url":84},"Aviso legal",{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":172,"group":48,"menu":173},"Atención al cliente",[174,175,176],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},[178,185,196,204],{"title":179,"group":48,"menu":180},"Entreprise",[181,183,184],{"title":182,"url":52},"Nos enseignants",{"title":54,"url":55},{"title":57,"url":58},{"title":186,"group":48,"menu":187},"Produit",[188,189,190,191,192,193,194],{"title":38,"url":7},{"title":65,"url":66},{"title":68,"url":69},{"title":71,"url":72},{"title":74,"url":75},{"title":15,"url":77},{"title":195,"url":10},"Tarification",{"title":197,"group":48,"menu":198},"Mentions légales",[199,200,201,202,203],{"title":197,"url":84},{"title":86,"url":87},{"title":89,"url":90},{"title":92,"url":93},{"title":95,"url":96},{"title":205,"group":48,"menu":206},"Service client",[207,208,209],{"title":101,"url":102},{"title":104,"url":105},{"title":107,"url":108},{"content":211,"related":282,"meta":354,"internal":364},{"title":212,"leadIn":213,"category":214,"elements":217,"becomeAnExpert":250,"author":272,"readDuration":280,"readDurationFormatted":281},"Making sense of common Holter ECG findings","There are some findings on a Holter monitor recording you expect, for example atrial fibrillation or premature ventricular complexes (PVCs). How do you report on it in clear and precise language? Our expert highlights common findings and reviews terms you should use to describe them.\r\n",{"id":215,"name":216},1,"Course previews",[218,228,233,238,245],{"type":219,"data":220},"video",{"readDurationInSeconds":221,"video":222},335,{"platform":223,"name":212,"url":224,"size":225},"YouTube","https:\u002F\u002Fwww.youtube.com\u002Fwatch?v=9Tmbm0MDfos",{"width":226,"height":227},200,113,{"type":229,"data":230},"free_text",{"readDurationInSeconds":231,"text":232},9.866666666666667,"\u003Cp>There are some findings on a Holter monitor recording you expect, for example atrial fibrillation or premature ventricular complexes (PVCs). How do you report on it in clear and precise language? Our expert highlights common findings and reviews terms you should use to describe them.\u003C\u002Fp>",{"type":229,"data":234},{"readDurationInSeconds":235,"title":236,"text":237},19.46666666666667,"Join our Holter Monitoring Essentials Course now!","\u003Cp>Holter monitoring is an essential tool in every clinician’s kit. This course will give you the confidence to select the best type of ECG monitor for your patient’s clinical indication, maximize diagnostic yield, and identify and troubleshoot the most common problems. You’ll learn how to correlate your patient’s symptoms with the rhythm strip and confidently report your findings. Become a master in Holter monitoring and confidently analyze and report monitoring results with this course.\u003C\u002Fp>",{"type":239,"data":240},"cta",{"readDurationInSeconds":241,"text":242,"buttonText":243,"buttonUrl":244},3.466666666666667,"Become a great clinician with our video courses and workshops","Start learning for free","https:\u002F\u002Fwww.medmastery.com\u002Fuser\u002Fregister",{"type":229,"data":246},{"readDurationInSeconds":247,"title":248,"text":249},160,"Video transcript","\u003Cp>When you analyze a Holter recording, there are some arrhythmias that you'll encounter commonly. Let's take a look at some of those now. The most common sustained arrhythmia we see on Holter recordings is atrial fibrillation. It's identified by its irregularly irregular character, and by the absence of any discernible repeating P wave activity. In persistent atrial fibrillation Holter monitoring can provide valuable information about ventricular rate.\u003C\u002Fp>\u003Cp>For instance, when we want to assess the effectiveness of rate controlling medications such as beta blockers. Atrial fibrillation can also be paroxysmal. By convention, in accordance with published guidelines, we only label an episode as a paroxysm of atrial fibrillation on Holter monitoring if it has lasted for 30 seconds or longer. It's important to report any such episodes of AF that you see because paroxysmal atrial fibrillation is associated with an increased risk of stroke, even when it is asymptomatic.\u003C\u002Fp>\u003Cp>What terminology should we use for episodes that look like AF, but that are shorter than 30 seconds? Well, there's no consensus on this. One option is to refer to such an episode as an atrial arrhythmia without P waves and with irregular ventricular response lasting less than 30 seconds. This description is a little cumbersome, but it conveys the key features of the event without applying the clinical label of atrial fibrillation.\u003C\u002Fp>\u003Cp>Premature ventricular complexes or contractions abbreviated to PVCs are also sometimes called ventricular ectopic beats are another common finding on Holter recordings. They're identified as broad QRS complexes, lasting more than 120 milliseconds and their abnormal morphology which varies according to their points of origin within the ventricles. They occur prematurely, that is earlier than the next normal beat would have occurred, and are usually followed by a compensatory pause.\u003C\u002Fp>\u003Cp>PVCs can be described as unifocal, when they all originate from the same location and share the same morphology. They can also be labeled multi-focal If they originate from different locations and therefore their morphology varies. You need to report any PVCs that are associated with symptoms such as palpitations. Therefore, it's important to check the patient's symptoms diary to see whether any of the PVCs correspond to events that the patient has recorded.\u003C\u002Fp>\u003Cp>You also need to report the number and frequency of palpitations whether symptomatic or not, I recommend reporting the total number of PVCs during the recordings expressed that value as a percentage of the total heartbeat seen. I also report the average frequency of PVCs per hour. It's recognized that patients with very frequent PVCs such as 20,000 or more during a 24-hour Holter recording, run a risk of PVC induced cardiomyopathy.\u003C\u002Fp>\u003Cp>For this reason, you always need to report on overall PVC numbers whether they're symptomatic or not. ventricular tachycardia, or regular wide complex tachycardia is another relatively common arrhythmia on Holter monitoring, particularly as a brief incidental finding. However, it can be associated with serious symptoms such as syncope, and may indicate a risk of sudden cardiac death. He must therefore always report any episodes of VT that you see whether they are symptomatic or not. We often categorize episodes of VT as sustained or non-sustained.\u003C\u002Fp>\u003Cp>If an episode lasts more than 30 seconds, it's sustained less than 30 seconds is non-sustained. VT can also be described as monomorphic, when all the QRS complexes have the same shape, it can be labeled polymorphic when the shape changes from one beat to the next. The final common finding that I'd like to highlight are pauses. These can be caused by sinus arrest or sinoatrial block, in which case P waves are absent, or due to atrioventricular block, in which case you will see evidence of atrial activity but no ventricular activity.\u003C\u002Fp>\u003Cp>Either way, pauses causes cessation of ventricular activity for a period of time and could often be associated with dizziness and syncope. As such, it's important to comment on the presence of any pauses that you see, and to record whether they are symptomatic and how long they lasted. It's also important to try and identify whether the pauses were due to atrioventricular block by looking for any evidence of background atrial activity. All of these factors will help to determine whether or not a pacemaker may be indicated. In summary, there are several arrhythmias that you will commonly encounter during the analysis of Holter recordings. It's important to include details of these in your reports not only because they may be the cause of the patient's symptoms but also because they can carry risks and clinical implications for the patient even when asymptomatic.\u003C\u002Fp>",{"courses":251,"showAwardsBelow":48},[252],{"id":253,"isFreeCmeCourse":254,"title":255,"type":256,"specialization":257,"teachers":259,"cmeCredits":261,"teacherIllustration":262,"backgroundImage":263,"relativeUrl":264,"lastChanged":265,"created":266,"description":267,"relativeURL":264,"meta":268},10054,false,"Holter Monitoring Essentials","course",[258],"Cardiology",[260],"Cara Mercer",2,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55e5d-104f-4629-97d3-0007884aa494","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F99f55e5e-20a8-46ea-9dc9-65f422d9c43d","\u002Fcourses\u002Fholter-monitoring-essentials","1763556347","1644188770","Holter monitoring is an essential tool in every clinician’s kit. This course will give you the confidence to select the best type of ECG monitor for your patient’s clinical indication, maximize diagnostic yield, and identify and troubleshoot the most common problems. You’ll learn how to correlate your patient’s symptoms with the rhythm strip and confidently report your findings.",{"duration":269,"quizzes":270,"lessons":271},4130,3,21,{"id":273,"name":260,"image":274,"profession":275,"relativeUrl":278,"specializations":279},10053,"https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf05-cc89-4f5a-9100-7111592144e8",{"name":276,"description":277},"Chief Cardiac Physiologist","Cara is a Chief Cardiac Physiologist at United Lincolnshire Hospitals NHS Trust (Grantham and District Hospital), UK.","\u002Fteachers\u002Fcara-mercer",[258],205,"4m",[283,311,330],{"id":284,"title":285,"text":286,"image":287,"author":295,"path":304,"readDuration":305,"readDurationFormatted":306,"internal":307},1350,"How to Recognize INOCA (ANOCA) on an Exercise Stress Test ","Angina, abnormal stress test, clean coronaries—that's INOCA (or ANOCA), and it carries real risk. Learn to recognize and report it with exercise stress ECG.",{"alt":288,"title":289,"size":290,"location":292},"Illustration of the heart's coronary vasculature showing large coronary arteries and the extensive network of smaller vessels affected in INOCA (ischemia with nonobstructive coronary arteries).","",{"width":291,"height":291},1200,{"bucket":293,"key":294},"public-drupal-medmastery-assets-production","\u002F2026-05\u002FC17(1)_magazine image_0.png",{"id":296,"title":297,"relativeURL":298,"image":299,"professionLong":300,"profession":301,"weight":303},1563,"Franz Wiesbauer, MD MPH","\u002Fteachers\u002Ffranz-wiesbauer-md-mph","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cef0-41ee-4005-9e4a-d8711c816401","Franz is the founder and CEO of Medmastery. He is an internist with a specialization in cardiology and a master’s in public health from Johns Hopkins University.",{"name":302},"Internist",4,"\u002Fmagazine\u002Fexercise-stress-ecg-inoca",141,"3m",{"created":308,"updated":309,"published":310},1778115738,1778118425,1778118255,{"id":312,"title":313,"text":314,"image":315,"author":321,"path":323,"readDuration":324,"readDurationFormatted":325,"internal":326},1348,"Hyperlipidemia screening: who, when, & what to measure","Testing for hyperlipidemia can help you mitigate your patients' cardiovascular risk. Learn who to screen and when, which measures to request, and how to stratify risk.",{"alt":316,"title":289,"size":317,"location":319},"Lipid panel blood sample tubes used to test for hyperlipidemia in a laboratory setting",{"width":318,"height":318},600,{"bucket":293,"key":320},"\u002F2026-04\u002FC121_magazine image.png",{"id":296,"title":297,"relativeURL":298,"image":299,"professionLong":300,"profession":322,"weight":303},{"name":302},"\u002Fmagazine\u002Ftest-for-hyperlipidemia",246,"5m",{"created":327,"updated":328,"published":329},1777403036,1777572381,1777412421,{"id":331,"title":332,"text":333,"image":334,"author":339,"path":348,"readDuration":349,"readDurationFormatted":281,"internal":350},1347,"Outpatient care for COPD exacerbations","Most acute COPD exacerbations can be managed with outpatient treatment. Learn how to treat mild and moderate COPD exacerbations—and when to escalate care.",{"alt":335,"title":289,"size":336,"location":337},"Older patient using a handheld nebulizer to inhale bronchodilator medication during an acute COPD exacerbation",{"width":318,"height":318},{"bucket":293,"key":338},"\u002F2026-04\u002FC133(4)_ exacerbations_magazine image.png",{"id":340,"title":341,"relativeURL":342,"image":343,"professionLong":344,"profession":345,"weight":347},5365,"Siamak Moayedi, MD","\u002Fteachers\u002Fsiamak-moayedi-md","https:\u002F\u002Fmedmastery-backend-prod-kjbeds.s3.eu-west-1.amazonaws.com\u002Fmedia\u002Fimages\u002F9c43cf02-1064-4074-817b-0eb5de6ded74","Professor and Director of Medical Student Education, University of Maryland and Course Director, Essential and Critical Procedures, Emergency Medicine.",{"name":346},"Emergency medicine physician",1533,"\u002Fmagazine\u002Facute-copd-exacerbation-treatment",191,{"created":351,"updated":352,"published":353},1776705362,1776710540,1776710541,{"seo":355,"og":357},{"title":356,"description":213},"Making sense of common Holter ECG findings | Medmastery",{"title":356,"description":213,"image":358},{"alt":289,"title":289,"size":359,"location":362},{"width":360,"height":361},606,364,{"bucket":293,"key":363},"\u002Fmigrated-images\u002F03-Making sense of common Holter ECG findings.png",{"id":365,"created":366,"updated":367,"published":366},10,1643653933,1655189586]