This document discusses how to identify and cut different types of EKG recordings from various Holter monitors. It provides guidance on identifying patient-activated recordings versus automatically triggered ones based on calibration boxes, symbols or patterns at the start of recordings. It also outlines rules for cutting, labeling and saving the recordings as new events based on their type, including selecting the appropriate activation type of patient or auto-trigger.

1. In this power point we will go over what monitors are what, how to identify
what recordings are patient activated versus auto triggered. We will also
discuss cutting and labeling rules.

2. Calibration Boxes
Calibration boxes will be seen in both Heartrak Looping monitors and
Heartrak Handheld monitors. The are found in the beginning of each
recording to help identify the starting and ending of recordings, as well as it
allows you to see where you are in a grouping of recordings.
If you use a filter ‘Baseline Normalization’ when cutting or editing recordings it
may distort the way the calibration boxes looks.
You will see similar looking boxes with other monitors, however; they are not
calibration boxes and will be explained with each device.
This calibration box
symbolizes the first
recording of what could be
several recordings off a
handheld monitor.
These calibration boxes
symbolize the end of first
recording and the start of
the second recording off a
looping monitor.

3. Heartrak Smart Looping Monitors
90 seconds Pre - Activation 30 seconds Post - Activation
Auto - Trigger Patient Activated

4. Heartrak 2-200
In the beginning of each
recording you will see
calibration box(es) to let
you know what number
recording you are on.
There is no “Pre-
Activation,” so there is a
Universal Symbol for
Record in the beginning.
The time and date stamp
will be found in the
beginning of the
recording.

5. Heartrak Smart 97 w/ a Screen
This monitor does not have calibration boxes in the middle, nor does it have “Trigger Marks” like
the other Heartrak Looping monitors. Instead we identify whether it is Patient Activated or Auto
Trigger from the beginning of each recording (as seen below). As you can see the two are very
similar. The only thing that is different is the Auto Trigger has (1) extra spike in the beginning.
To decipher between Pre Activation and Post Activation with in the recordings on this monitor
you will look for the “universal symbol for record.” This has been seen twice already: directly
attached to Heartrak smart Looping Trigger marks and the beginning of the Handheld
recordings; after the calibration box. See below.
Universal Symbol for Record
Auto - Trigger Patient Activated

6. King of Hearts
Like the Heartak 97 w/ a Screen, the King of Hearts monitor does not have calibration
boxes in the middle, nor does it have “Trigger Marks.” Instead we identify whether it is
Patient Activated or Auto Trigger from the beginning of each recording (as seen below).
As you can see the two are very similar. The only thing that is different is the Auto Trigger
has (2) boxes in the beginning and Patient has one box.
To decipher between Pre Activation and Post Activation with in the recordings on this
monitor you will look for the “universal symbol for record.” This has been seen twice
already: directly attached to Heartrak smart Looping Trigger marks and the beginning of
the Handheld recordings; after the calibration box.
Note: The boxes in the beginning are NOT calibration boxes.
Auto - Trigger Patient Activated

7. King of Hearts Express
Like the other King of Hearts monitor, this king of hearts does not have calibration boxes
in the middle, nor does it have “Trigger Marks.” Instead we identify whether it is Patient
Activated or Auto Trigger from the beginning of each recording (as seen below). As you
can see the two are very similar. The only thing that is different is the Auto Trigger has (2)
boxes in the beginning and Patient has one box.
To decipher between Pre Activation and Post Activation with in the recordings on this
monitor you will look for the “universal symbol for record.” This has been seen twice
already: directly attached to Heartrak smart Looping Trigger marks and the beginning of
the Handheld recordings; after the calibration box.
Note: The boxes in the beginning are NOT calibration boxes. Also, there isn’t a big gap
between recordings.
Patient Activated Auto Trigger

8. Cutting / Labeling Rules
Ask yourself questions about the recordings
1. Are all of your recordings patient activated?
If so, cut the first recording. Change the Strip
Description to PATIENT EKG STRIP and save it
as Additional.
Cut the rest of the recordings in a sequential order. Each remaining recording should be
saved as a new event. Check the new event box first, then change your Strip Description to
PATIENT EKG STRIP. Before saving, select Patient under the activation type.

9. 2. Do you have any auto trigger recordings?
If yes, the first step would be to check the doctors office to rule out the fact
That it maybe a special account. ( Dr. Muhommad Jammour )
• If it is one of the special accounts, follow the same steps listed in rule
number 1. However, when you are saving new events make sure to properly
select an activation type.
• If all of your recordings are auto but they are not a special account, no
cutting or saving is needed.
3. Do you have a mixture of patient activated recordings and auto
trigger recordings but, it is not a special account?
If yes, cut all of the patient activated recordings out individually in a
sequential order. Save them each as new events, change the Strip
Description to PATEINT EKG STRIP and select Patient under the
Activation type.

10. Cardiostation will not allow you to exit the screen after cutting unless you dominantly
name/label the recording. To do this, Click on the ECG tab at the top of your screen
and select Patient Activation or Auto-Trigger. Rules are as followed below.
If your recordings are all patient activated choose Patient Activation.
If your recordings are all Auto-Triggered choose Auto-Trigger.
If your recordings are a mixture of patient, and auto activated choose Auto-trigger.
After these steps, go into each individual recording and
document symptoms, activity, date and time. When finished and
if needed, include your initials and a “/” symbol. Ex. MZ/