A 61 year old man has been referred to the OPD with frequent episodes of breathlessness and chest pain along with palpitations. He has a regular pulse rate 60bpm. ECG sinus rhythm. What is the most appropriate investigation to be done?

The key is E. 24h ECG. [Episodic breathlessness, chest pain and palpitations are suggestive of

paroxysmal arrhythmia. As paroxysmal arrhythmia it will only be evident during attack and in between

attacks ECG will be normal (as in given case). So to confirm the diagnosis 24h ECG should be done].

Indications of 24 h ambulatory holter monitoring:

1. To evaluate chest pain not reproduced with exercise testing

2. To evaluate other signs and symptoms that may be heart-related, such as fatigue, shortness of

breath, dizziness, or fainting

3. To identify arrhythmias or palpitations

4. To assess risk for future heart-related events in certain conditions, such as idiopathic

hypertrophic cardiomyopathy, post-heart attack with weakness of the left side of the heart, or

Wolff-Parkinson-White syndrome

5. To assess the function of an implanted pacemaker

6. To determine the effectiveness of therapy for complex arrhythmias