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What does 24 hour holter monitor report indicate?

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Posted on Mon, 1 Jun 2015
Question: My 24 hour holter monitor report says something about "ST Depression":
Ch 1 - Total Episodes: 3; Total Duration(minutes): 68.6; Maximum Depression: -1.5; Slope: H
Ch 2- Total Episodes: 4; Total Duration (minutes): 101.1; Maximum Depression: -1.5; Slope: H
I was using the holter monitor to evaluate a high heart rate presumably from my thyroid problem - I was taking 60mg propranolol er at the time, and I felt no symptoms at all. My heart rate was not high while this was happening. I also wore the holter during exercise and none of this happened during that time. I am 33, female, normal height and weight, normal cholesterol and blood work, normal echo, normal chest X-ray.
I do not understand what this means, but when I've google ST Depression, it seems quite ominous and now am very concerned. I have not heard back from my doctor since this report was mailed to me 2 weeks ago.
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Answered by Dr. Ilir Sharka (1 hour later)
Brief Answer:
ST depressions caught by Holter device do not have clinical significance.

Detailed Answer:

Hello XXXX!

THank you for asking on HCM!

I understand your concern, and after passing carefully through your medical history and test prescription, I would explain that ST depressions should not be taken into consideration, as they are not related to any existing myocardial ischemia at all.

These ST depressions episodes are not symptom - related; they do occur without performing exercise, and they are not reproduced when exercising (as you refer above).

As I have a long experience on rhythm monitoring and ischemic heart disease, I would like to confirm you that, the most reliable and medically reasonable explanation for those findings are artefact events (registered erroneously by the monitoring device as an important repolarisation abnormality).

Remember that Holter monitoring is a dynamic test (it keeps registering your heart rhythm on everyday activity settings, such as moving, sleeping, running, bending, turning around, dressing,etc).

So, it is almost quite impossible to have an ideal registering, free of artefactual events. Those rhythm monitoring systems, lack of adequate precision, regarding repolarisation abnormalities (dependence form registering quality, and noise presence, etc).

That's why it is of utmost importance to have a careful review of entire registering from an expert eye (cardiologist).

You can also discuss with your doctor for further assurance.

At the end, I am glad to conclude that the underlying episodes that rightly caught your attention, have neither any clinical significances, nor any other important meaning.

You have to relax! Nothing to worry about!

Hope to have been helpful to you.

Feel free to ask me whenever you need. Greetings! Dr. Iliri


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Answered by
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Dr. Ilir Sharka

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Practicing since :2001

Answered : 8724 Questions

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What does 24 hour holter monitor report indicate?

Brief Answer: ST depressions caught by Holter device do not have clinical significance. Detailed Answer: Hello XXXX! THank you for asking on HCM! I understand your concern, and after passing carefully through your medical history and test prescription, I would explain that ST depressions should not be taken into consideration, as they are not related to any existing myocardial ischemia at all. These ST depressions episodes are not symptom - related; they do occur without performing exercise, and they are not reproduced when exercising (as you refer above). As I have a long experience on rhythm monitoring and ischemic heart disease, I would like to confirm you that, the most reliable and medically reasonable explanation for those findings are artefact events (registered erroneously by the monitoring device as an important repolarisation abnormality). Remember that Holter monitoring is a dynamic test (it keeps registering your heart rhythm on everyday activity settings, such as moving, sleeping, running, bending, turning around, dressing,etc). So, it is almost quite impossible to have an ideal registering, free of artefactual events. Those rhythm monitoring systems, lack of adequate precision, regarding repolarisation abnormalities (dependence form registering quality, and noise presence, etc). That's why it is of utmost importance to have a careful review of entire registering from an expert eye (cardiologist). You can also discuss with your doctor for further assurance. At the end, I am glad to conclude that the underlying episodes that rightly caught your attention, have neither any clinical significances, nor any other important meaning. You have to relax! Nothing to worry about! Hope to have been helpful to you. Feel free to ask me whenever you need. Greetings! Dr. Iliri