Use of the Holter electrocardiographic monitor in the diagnosis of transient ischemic attacks.

The diagnosis of transient ischemic attacks usually is based on an accurate history and physical examination (with the finding of carotid bruits), a complete neurologic examination, a brain scan, an encephalogram and an angiogram. Recently the Holter technique for continuous 24-hour electrocardiographic monitoring has been used as a diagnostic aid in these problem cases. Severe bradycardia, sick sinus syndrome, tachy-brady syndrome, recurrent tachycardia and heart block have been found to be the cause of the central-nervous-system symptoms in aged atherosclerotic patients. Correction with anti-arrhythmia drugs and pacemakers, with or without carotid endarterectomy, has been highly successful. Data are presented on 204 patients tested by Holter monitoring over a 2.5-year period in a small community hospital; 6 cases are illustrated in detail. The Holter monitor is a valuable tool in evaluating the patients with cerebrovascular insufficiency.