The Warning Signs of Acute Pulmonary Embolism in Holter Heart Monitor

Acute pulmonary embolism (APE) is a life-threatening condition characterized by obstruction of blood clots in one of the pulmonary arteries.

00:27 25 October 2024

Acute pulmonary embolism (APE) is a life-threatening condition characterized by obstruction of blood clots in one of the pulmonary arteries, causing a reduced blood supply to the lung vasculature and putting immense stress on the pumping ability of the heart. Although it is difficult to detect a pulmonary embolism due to its resemblance with other respiratory disorders, an early diagnosis is necessary to avoid further complications. 

One of the methods is to find abnormalities in cardiac rhythms via a Holter Heart Monitor. It is a portable ECG tool that can detect early changes in ECG that indicate the development of a pulmonary embolism. This article explores the warning signals of acute pulmonary embolism and elaborates on the role of Holter's heart monitors in early diagnosis and management. 

What is acute pulmonary embolism?

Acute pulmonary embolism is a condition that occurs when a blood clot (embolus), which typically originates from deep vein thrombosis, primarily in the veins of calves, travels through the bloodstream and obstructs the pulmonary arteries. 

This condition is characterized by a pulmonary embolism, blocking blood flow to the lung vasculature. In addition, a significant amount of stress is placed on the heart due to the limitation of blood flow to the lungs (because the heart has to work extra hard to pump blood into the obstructed pulmonary vasculature) and the subsequent reduction in oxygen saturation.

The symptoms of Acute Pulmonary Embolism can vary to a great extent, making early diagnosis challenging. Common symptoms may include:

• Difficulty breathing
• Pleuritic chest pain
• Tachycardia (Increased heart rate)
• Light-headedness
• Anxiety or a sense of imminent disaster.
• Coughing, occasionally with blood (Hemoptysis).

Long periods of immobility, surgery, pregnancy, and hyper-coagulable disorders such as cancer and smoking all increase the risk of APE. Individuals with these symptoms or risk factors should seek medical assistance immediately to avoid the severe consequences of the illness. 

Copyright picture from https://www.ajconline.org/article/S0002-9149(20)30553-1/

How A Holter Heart Monitor Detects Acute Pulmonary Embolism?

A Holter heart monitor is powerful for detecting aberrant heart activity for 24 to 48 hours, particularly in patients at risk of APE. This portable ECG equipment continuously monitors the heart's electrical activity, recording critical information that could indicate a pulmonary embolism.

Holter monitors can detect early indicators of APE by analyzing particular ECG abnormalities. When diagnosing APE, clinicians check for the critical ECG alterations listed below:

• SIQIIITIII Changes: A common electrocardiographic finding in acute pulmonary embolism. It describes a deep S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III. Although these alterations are not unique to APE, they are reliable indications of the illness.
• T-wave inversion in leads V1–V3 is a typical ECG indication of APE. It is an early sign particularly prominent in patients with pulmonary embolism, showing strain on the right side of the heart.
• APE patients frequently have Right Bundle Branch Block (RBBB), a transient abnormality in the electrical conduction system of their hearts. RB is caused by increased tension on the right side of the heart due to pulmonary arterial obstruction.
• Severe APE can produce lead aVR enlargement, ST-segment elevation, and lateral ST-segment depression. These alterations indicate a significant strain on the heart and are related to a more severe embolism.
• ST-Segment Elevation: While commonly associated with heart attacks, it can also indicate pulmonary embolism. However, it can mislead clinicians because it is easily mistaken with other cardiac episodes. Healthcare practitioners must interpret these results in light of the patient's symptoms and risk factors.
• Brugada waves may affect ECG measurements during APE. Brugada syndrome characterizes a substantial risk of abrupt cardiac death. Its electrocardiographic appearance can resemble that of APE, emphasizing the importance of careful examination by qualified clinicians.
• Pulmonary P Waves: These P waves are higher and sharper than typical, indicating elevated pressure in the right atrium due to APE.

The Function of Novel ECG Score Sheets

Advances in ECG technology have resulted in innovative ECG score sheets, which provide a more complete approach to understanding the numerous alterations associated with APE. These score sheets incorporate various ECG characteristics, making a more accurate and reliable diagnosis. Using such modern techniques in conjunction with Holter's heart monitors guarantees that even minor changes in cardiac activity are identified early on, allowing for timely intervention.

EDAN ECG Machine SE-1202

For hospitals and clinics wishing to increase their diagnostic skills, the EDAN SE-1202 ECG machine has been proven to be powerful and accurate for clinical care. 

 Innovative Design

• All-Glass Panel with Large Function Buttons: The SE-1202 features a sleek, easy-to-clean all-glass front panel and large buttons, ensuring effortless one-touch operation while maintaining superior hygiene standards.
• 12-Lead Standard and 9-Lead Pediatric Mode: It supports both adult 12-lead ECG and a specialized 9-lead mode for children, equipped with child-specific algorithms for age-appropriate diagnosis.

Precision Algorithms

• Certified SEMIP Analysis Algorithm: The SE-1202 is powered by the SEMIP algorithm, certified by the European CSE, American AHA, and MIT databases, ensuring precise automatic ECG measurements for faster and more accurate diagnoses.
• ST-VIEW: This feature provides a graphical display of the ST segment, using colour-coded indicators to easily visualize normal, elevated, or depressed ST segments across all leads, simplifying patient condition assessments.

High-Performance Monitoring

• High-Performance ECG Module: With a high sampling rate and wide frequency response, the SE-1202 captures undistorted, high-quality ECG signals, ensuring reliable data for diagnosis.
• Multiple Operating Modes: The device offers various modes, including manual, automatic, rhythm, heart rate variability, vector, and late potential, catering to different clinical needs.
• Extended Waveform Capabilities: The SE-1202 supports up to 30 minutes of waveform collection, storage, and review, along with the ability to compare different ECG records for the same patient over time, facilitating the repetitive checking.
• Network Integration: With wired, wireless, and mobile network options, the SE-1202 supports DICOM and HL7 protocols for smooth communication with hospital HIS/EMR systems, meeting the requirements of digital healthcare environments.

Conclusion

Detecting acute pulmonary embolism early is critical for avoiding life-threatening consequences. A Holter heart monitor, with continuous ECG recording, is an effective technique for detecting the warning signs of APE. 

EDAN has been committed to providing more phenomenal clinical devices for higher accuracy, quicker result rates, and more comfortable design. Visit their website for more patient-and-healthcare-provider-center solutions.