DEAR DR. GOTT: I am a 76-year-old man who has just had a EGD/colonoscopy. During the procedure something happened and I was awakened in the middle of it. It seems that my heart either stopped or slowed way down. I did not have any residual effects from this but my doctor would like me to wear a Holter monitor. Can you tell me what a Holter monitor is and how and why it is used?
DEAR READER: An EGD is an esophagogastroduodenoscopy or upper endoscopy, a test that examines the lining of the esophagus, stomach and a small portion of the small intestine. It is performed with a small camera inserted into the throat that will allow your physician to evaluate possible abnormalities.
It is typically performed because of unexplained anemia, weight loss, heartburn, regurgitation, swallowing difficulties, bleeding, or other issues. If the esophagus and tract are found to be smooth and normal in color, the test will be considered negative. If, however, there were positive findings, you may have a duodenal ulcer in the small intestine, hiatal hernia, gastroesophageal reflux disease (GERD), polyps, narrowing of the esophagus, cancer, or other difficulties, most of which are treatable.
A colonoscopy is a similar procedure except that it is done from the “other end” and examines the colon and large intestine. It is normally performed for two reasons; first because of symptoms such as rectal bleeding, chronic diarrhea or constipation, or second as a routine screening procedure due to age to check for polyps, cancer, and more.
It is my guess you had a reaction to the medication used during the procedure that might have caused sweating, bradycardia (a slowed heart rate), difficulties breathing, or even apnea that caused you to stop breathing altogether. This was why you were awakened in the middle of the procedure. Your physician or gastroenterologist should have warned you during your pre-operative examination of the possibility these common side effects, even though extremely rare, could occur. Whatever occurred, he or she did the correct thing by discontinuing the procedure.
My guess is that the performing physician has taken the safe approach by ordering a Holter monitor, a device that resembles a cell phone or pager, that you will wear constantly for up to three days to record your heart rhythm and rates. During that period you will function as you normally do, every hour of every day to include sleeping, and will keep a simple journal or log of activities and any symptoms you may experience. Your physician can then use the information provided by the device in conjunction with your journal to determine if you have difficulties or abnormalities with the beating of your heart.
There are no risks involved with wearing the Holter and the only considerations are that it doesn’t get wet and you should not walk through a metal detector while it is on. There are some instances that will prevent your physician from diagnosing your condition. When this occurs, you may be required to wear an event monitor which is worn every day and activated by hand whenever symptoms are felt, but that’s further down the list and may not be necessary.
It appears to me that you are receiving appropriate care by a knowledgeable physician. Put your trust in him or her and follow the advice given. Don’t forget, if you have questions just ask and don’t leave the office until the doctor satisfactorily answers in a way that you can understand.
Readers who would like related information can order my Health Report “Coronary Artery Disease” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at P. O. Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.
