Cardiac Telemetry Monitoring

Overview

Cardiac telemetry monitoring means watching your heart's rhythm non-stop over a period of time. Small sticky patches called electrodes are placed on your chest. They pick up the tiny electrical signals your heart makes with every beat and send them to a small device, which passes them to a screen your care team can see. This lets staff spot changes in your heart rhythm at any time - even while you sleep or when no one is in the room. Most telemetry happens in hospital, often on a general ward or a heart unit. Some types are done at home, where you wear a small monitor for a day or longer while you get on with normal life.

Yes. Telemetry is one of the most common heart checks in hospitals, and millions of people wear a heart monitor every year. Home monitors are also very widely used.

It can be used for anyone whose heart rhythm needs checking. That includes people with chest pain, a fluttering or racing heartbeat, dizziness, fainting, a known heart rhythm problem, or recovery after heart treatment. It is also used when starting or changing a heart medicine, and when another illness could affect the heartbeat.

Symptoms

Common symptoms

• A fluttering, pounding or racing feeling in your chest (palpitations)
• Feeling dizzy or light-headed
• Fainting or nearly fainting
• Chest pain or tightness
• Shortness of breath, especially with activity
• A pulse that feels very fast, very slow or uneven
• Feeling very tired or weak for no clear reason
• No symptoms at all - telemetry often picks up changes you cannot feel

Causes

Main causes

• To check a heartbeat that is fast, slow or uneven
• To watch for changes after a heart attack or a heart procedure
• To see how well a heart medicine is working, or whether it is affecting the rhythm
• To look into fainting or dizziness with no clear cause
• To monitor someone with a known rhythm problem, such as atrial fibrillation (an uneven heartbeat that starts in the upper chambers of the heart)
• To check the heart when another illness, such as a severe infection or an imbalance of body salts, could affect the heartbeat

Risk factors

• Getting older - heart rhythm problems are more common with age
• High blood pressure, heart disease, heart valve problems or heart failure
• An overactive or underactive thyroid gland
• Sleep apnoea (a condition where breathing stops and starts during sleep)
• Drinking a lot of alcohol, or using stimulant drugs
• Some medicines, including certain cold and flu remedies
• A family history of heart rhythm problems
• Heavy caffeine use, poor sleep and long-term stress can trigger palpitations, though they rarely cause serious rhythm problems on their own

When to see a doctor

See a doctor urgently if:

• You have chest pain, severe breathlessness or you faint
• Palpitations do not stop, or come with dizziness, sweating or feeling unwell
• You notice a very fast or very slow pulse that lasts
• You have swelling in your legs or sudden weight gain

Book a routine appointment if:

• You have occasional palpitations but otherwise feel well
• Your pulse feels unusually fast, slow or uneven at rest
• You feel more tired or breathless than usual during everyday activity
• A close relative has a heart rhythm problem or a heart device
• You have a health condition that can affect the heartbeat, such as thyroid disease or high blood pressure

Diagnosis

Telemetry is itself the test. Your care team places several small sticky patches on your chest, and these connect by thin wires to a small device. In hospital, the device sends your heart's signals to a screen at the nurses' station. It runs all day and night for as long as your team needs - often a few hours, sometimes several days. The recording is then reviewed, often by a heart specialist, and any changes in rhythm are matched up with the times you felt symptoms.

Tests that may be done

• Electrocardiogram (ECG) - a short recording of your heart's electrical signals made in the clinic
• Blood tests - to check for heart muscle strain, body salt levels, thyroid, kidney and blood count
• Echocardiogram - an ultrasound scan that shows the heart's shape and how well it is pumping
• Chest X-ray
• Ambulatory monitor - a Holter monitor worn for 24 to 48 hours, or an event recorder worn for longer
• Exercise or stress test - heart tracing while you walk on a treadmill or cycle
• A small rhythm monitor placed just under the skin for long-term recording, if needed

What to expect at your appointment

Having the patches put on takes only a few minutes. Your skin may be cleaned and possibly shaved in small spots so the patches stick well. The patches can feel slightly cold or sticky, but nothing is painful and there are no needles. You can usually eat, drink and move around, though you may need to ask for help to walk to the bathroom if you are attached to a bedside unit. Tell staff straight away if you feel any symptoms - the time you felt them helps them read the recording. Ask what you can and cannot do, such as showering, before you get set up.

Treatment

Telemetry does not treat anything by itself - it guides your care. What happens next depends completely on what the recording shows. If your heart rhythm is normal, you may need no treatment at all. If a problem is found, your team will explain what it is, how serious it is, and what the options are. Some rhythm changes need only watching, and others are easily treated.

Self-care at home

• Tell staff straight away if you feel palpitations, dizziness or chest discomfort, and note the time - it helps them match your symptoms to the recording
• Keep the device and wires dry unless your team says you can shower
• Do not pull off or move the sticky patches yourself
• Keep phones and other electrical items a safe distance away if your team advises it
• Ask for help getting to the bathroom if you are attached to a bedside monitor
• Tell staff if the patches itch, or if your skin turns red or sore
• Write down your symptoms, when they happen and what you were doing - this is useful for follow-up visits too

Medical treatments

Treatment depends on what the monitor finds. Options your team may discuss include: medicines to slow a fast heart rate or steady the rhythm; medicines to lower the chance of blood clots (often called blood thinners) when there is an uneven rhythm such as atrial fibrillation; treating an underlying cause, such as a thyroid problem or an infection; a short procedure to reset the heart's rhythm; or fitting a small heart device. Your care team will explain the choices, including the benefits and downsides, so you can decide together.

When is surgery considered?

Most people do not need surgery. Occasionally a procedure is needed - for example, fitting a pacemaker or an implantable defibrillator (a small device placed under the skin that corrects dangerous rhythms), or cardiac ablation (a procedure using a thin tube to treat the part of the heart causing an abnormal rhythm). These are usually short procedures, and your team will explain the risks and benefits clearly beforehand.

Living with this condition

While you are on telemetry, try to keep to your normal routine as much as your team allows - moving about, eating and sleeping as usual gives a more useful recording. After the monitor comes off, most people go back to normal straight away. If a rhythm problem is found, you may need follow-up appointments, occasional repeat heart traces, and possibly medicine. Many people find that knowing what is going on reduces their worry a great deal.

Lifestyle tips

• Cut down on alcohol and caffeine if you notice they trigger palpitations
• Stay active - regular gentle exercise is good for the heart
• Keep to a healthy weight and have your blood pressure checked
• Do not smoke, and avoid stimulant drugs
• Take any prescribed medicines as agreed, and check with your team before stopping
• Keep a simple diary of symptoms, times and triggers
• Go to your follow-up appointments, even if you feel well

Diet and exercise

A balanced diet is good for your heart - plenty of vegetables, fruit, whole grains, beans, nuts, fish and lean protein, with less salt, sugar and heavily processed food. Limit very salty foods and keep alcohol within recommended limits. For exercise, aim for moderate activity such as brisk walking most days, building up gradually. If you have a heart condition, ask your team what is safe for you - most people are encouraged to stay active, and you may be offered a cardiac rehabilitation programme, which is a supervised exercise and education course that many people find very helpful.

Mental health and emotional wellbeing

It is completely normal to feel anxious when your heartbeat is being watched, or after being told you have a rhythm problem. Palpitations can be frightening, and worry itself can make your heart race, which can feel like a loop. Talking about it helps. Tell your care team how you are feeling - they hear this often. If you feel overwhelmed or low for more than a couple of weeks, speak to your doctor. If you ever feel you cannot keep yourself safe, contact your local mental health crisis service or call your local emergency number straight away.

Prevention

You cannot always prevent needing telemetry, because it is used to check symptoms and to keep people safe after heart events. What you can do is lower your chance of heart rhythm problems in general: keep blood pressure and cholesterol in a healthy range, limit alcohol, avoid smoking and stimulant drugs, stay active, get enough sleep, and have conditions like thyroid disease treated.

Screening programmes

There is no routine screening programme for heart rhythm problems in the general population. However, if you have conditions such as high blood pressure, thyroid disease or sleep apnoea, regular check-ups help. Your doctor may also check your pulse at routine appointments, which is a simple way to spot an uneven heartbeat.

Complications

If left untreated

• Telemetry is only a test, so it has no complications of its own - the concern is what an undiagnosed rhythm problem could do over time
• An uneven heartbeat such as atrial fibrillation raises the risk of a stroke over the years
• A very fast rhythm can make the heart pump less well, causing breathlessness, dizziness or, rarely, collapse
• Fainting can lead to falls and injuries
• An untreated slow rhythm can cause ongoing tiredness and faints
• Long-term strain on the heart can lead to heart failure over time

Long-term outlook

The outlook is generally good. Most people who have telemetry have a normal recording or a mild, manageable rhythm change. When a problem is found, it is usually treatable with medicines, lifestyle changes or a short procedure, and finding it early is exactly the point of monitoring. Many people go on to live full, active lives with their rhythm well controlled.

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