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Additional tests that may be ordered after the Holter monitor results have been analyzed include:
- Event recorder (or event monitor). If a patient generally experiences symptoms only rarely, the Holter monitor may not pick up the pattern and thus may not alert the physician to the problem. Therefore, the physician may ask the patient to carry a different type of portable device called an event recorder or event monitor. Rather than monitoring the heart’s electrical activity continuously (as the Holter monitor does), an event recorder is used only when the patient is feeling symptoms. In those situations, the patient activates the event recorder by pressing a button. Because these devices are “on-demand” rather than continuous, these recorders may be used for weeks or months. In certain cases, they may do better at revealing the exact pattern of specific symptoms. Event monitors can also be equipped to transmit the results of their recording over the phone to the physician’s office, making it more convenient for the patient.
- Echocardiogram. This test uses sound waves to track the structure and function of the heart. A moving image of the patient’s beating heart is played on a video screen, where a physician can study the heart’s thickness, size and function. The image also shows the motion pattern and structure of the four heart valves, revealing any potential leakage (regurgitation) or narrowing (stenosis).
- Cardiac catheterization. A common, minimally invasive procedure in which a physician inserts a small tube called a catheter into a patient's blood vessel and passes the tube toward the heart. During this procedure, a number of different interventions may be done (e.g., balloon angioplasty).
- Electrophysiology study (EPS). An invasive test that uses electrode catheters positioned within the heart to directly evaluate the heart’s electrical system and to determine the cause of (and best treatment for) many types of abnormal heart rhythms (arrhythmias).
- Exercise stress test. An electrocardiogram (EKG) that is performed while the patient exercises in a controlled manner on a treadmill or stationary bicycle at varied speeds and elevations. The reaction of the heart under exertion can be measured and evaluated.
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