Where do I begin… this course was one of the most interesting courses I have taken thus far in the CAT program and yet was also one of the most frustrating. Holter monitoring involves a patient wearing a device that records a patient’s heart rhythm, similar to an EKG, but is worn for a 24-48hour period to catch any arrhythmias that occur throughout the day, possibly during activities, and also to assess pacemaker function. Our job as RCTs is to hook up the patient’s holter monitor, explain why the test is being performed and what to expect, give instructions to the patient on how to record events, disconnect the holter at the appropriate time, and analyze the recording for a cardiologist to review.
Aside from our few practice days in our clinical sites, the only abnormal arrhythmias we have seen are from our printouts, assignments, and online tools because in our labs we use each other as volunteers and rarely see anything other than normal sinus rhythm. This isn’t to say we are not well educated on arrhythmias because we absolutely are, it just means that we have not had much experience working with individuals who have a lot of rhythm abnormalities. That’s where I found this course to be very interesting! This was the first time we got to analyze and interpret 24-48 hours of a heart rhythm that was experiencing abnormalities. I caught myself reviewing the cases and being shocked how drastic some of them were. I even caught myself thinking “how can this person be walking around, their heart rate is dropping below 40bpm!”. This course was a real eye opener for how many heart issues people can have and made me appreciate my health more. I also enjoyed that this course was set up differently than any other course we have previously taken. Instead of having everyone together under one or two instructors, our class was split up among five or six instructors who we worked with individually on a weekly basis to work through our problems and get help where needed. The cases consisted of a broad range of situations from conduction or rhythm abnormalities to ST elevation and pacemaker assessment.
Now to the negative… Have you ever written a report for school, have finished it completely, and then for some unforeseen reason lost it entirely? It’s extremely frustrating right? Well that happens multiple times throughout this course due to how the program/software works. The software we used to analyze our cases was called holter care and helps you analyze the data by identifying premature beats, ST elevation, paced beats, tachy or brady rhythms, and pauses based on settings that you set. As with any program it has its downsides and this one is when the program fails to sense or over-senses beats due to how the patient’s normal heart beat looks like. For example if a patient has a tall tented T wave the program sometimes assesses it as a new beat instead of being part of the last QRS therefore it is listed as 2 beats rather than 1. If you think about how many times your heart beats a minute (average 70bpm) then think about how many beats an hour (70×60=4200), then how many beats a day (4200×24=100,800), that’s a whole lot of corrections that need to be made all due to the program over-sensing. Now the settings of this program allows you to make many changes and you can try to fix those issues by playing around with the settings but you usually cannot fix it all and have to make those corrections yourself. Another issue with this program (which we were warned about) is when you’re narrowing down and selecting the strips you want to include in your report, you cannot go back and make any changes to the case or all of your strips that were selected will be lost and you will have to go back and reselect everything. Having a heads up on this issue was useful but didn’t get rid of the frustration it brought when you had to go back and make a change because your instructor requested it or you noticed that you missed or mislabelled a beat. It always seemed to work out that you were just about finished and ready to submit your report when you notice one small error that you need to fix.
Overall, this course was a good one because it prepared us for what will be expected of us as RCTs analyzing holter cases when we start our clinical and or our jobs. Not all sites use the same software so I may never have to use the holtercare software again but with any program I am sure I will come across new issues and hopefully am now well equipped to deal with them.
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