Holter Symptom Diary

Patient name: ____________________________________________

Hospital number: _________________________________________

Date of recording: _____ / _____ / _____

Date of return: _____ / _____ / _____

Holter number: ___________________________________________

Technician: ______________________________________________

The ambulatory ECG monitor you have received today is designed to continually record your heart rate and rhythm; while you go about your normal daily routine.

Please note:

• Please do not open the recorder.
• If electrodes detach during recording please reapply to dry skin (see diagram) place micropore or elastoplast to hold in place if necessary.
• Do not pull wires and avoid touching electrodes.
• Please keep monitor dry at all times - do not bath or shower whilst wearing the monitor.
• Avoid contact with microwaves, industrial machinery and electric blankets. Mobile phones must be kept separated from monitor but can still be used.
• Once the monitor has been set up for you the buttons are inactive and will not interfere with the recording.
• Use the time on the monitor to record any symptoms.
• Remove the monitor and discard electrodes before returning to the department at the appointed time (9:00 or 12:00).
• Please return the monitor to the outpatient’s cardiology diagnostics department only.

Subject to the following:

• This equipment is used as part of the assessment of your condition, failure to return it within the specified time frame will delay your treatment and the assessment of other patients.
• The equipment at all times remains the property of Addenbrooke’s Hospital and must be returned at the end of the loan period in good working order.
• Failure to return the monitor on or before the loan date and time or any damage done to the monitor will result in the borrower being invoiced for the full cost of its replacement.

If you have any concerns please contact the department on: 01223 216990.