Joseph's Journey
Joseph Martinez, 52, is a software engineer in Toronto who spent three years searching for answers about his heart. What he experienced is unfortunately common: intermittent cardiac symptoms that disappear by the time you reach the doctor's office.
His story illustrates why continuous monitoring is transforming how we detect and treat arrhythmias—and how it might have prevented years of anxiety, multiple ER visits, and the very real risk of stroke that comes with undetected atrial fibrillation.
Note: Patient name and some details have been changed to protect privacy. Story shared with permission.
Living with Unexplained Symptoms
It started three years ago with what Joseph describes as "my heart doing gymnastics."
"I would be sitting at my desk coding, and suddenly I'd feel this fluttering in my chest. My heart would race, sometimes feeling irregular, and then just as suddenly, it would stop. By the time I could even think about calling my doctor, everything felt normal again."
Joseph's symptoms included:
- Sudden episodes of rapid, irregular heartbeat
- Shortness of breath during episodes
- Fatigue that lingered even after symptoms passed
- Anxiety about when the next episode would occur
- Episodes lasting anywhere from seconds to hours
"The worst part was the uncertainty," Joseph recalls. "I never knew when it would happen. Sometimes weeks would go by with nothing, then I'd have three episodes in one day. I started avoiding the gym, stopped playing hockey with my friends—I was afraid to be anywhere I couldn't easily get help."
The Frustration of Normal Results
Over three years, Joseph underwent multiple cardiac tests:
Year One:
- Emergency room visit during acute episode
- 12-lead ECG (performed after symptoms resolved): Normal
- Blood work including troponin and BNP: Normal
- Advised to follow up with family doctor
Year Two:
- 24-hour Holter monitor: Normal sinus rhythm
- Echocardiogram: Structurally normal heart
- Referred to cardiologist who ordered stress test: Normal
Year Three:
- Second ER visit with severe palpitations
- ECG again: Normal (symptoms had resolved)
- 48-hour Holter monitor: Occasional PVCs, "not clinically significant"
"Every test came back normal," Joseph says. "My cardiologist was sympathetic but didn't have answers. He mentioned that these intermittent arrhythmias can be incredibly hard to catch. I started to wonder if it was all in my head."
The limitation of short-term monitoring: Traditional 24-48 hour Holter monitoring captures only a brief window of cardiac activity. If a patient's arrhythmia doesn't occur during that specific window—which is common with paroxysmal AFib—the test will return normal results despite a real underlying condition.
The 14-Day Difference
Joseph's journey changed when his cardiologist learned about extended Holter monitoring covered by OHIP. He referred him to a clinic using Myant Health's SKIIN™ system.
"I was skeptical at first," Joseph admits. "I'd worn the traditional Holter twice with those sticky patches and wires. I couldn't shower, I couldn't sleep comfortably, and of course, my heart behaved perfectly during those 24 hours."
The SKIIN™ experience was different:
"They gave me what looked like a normal athletic chest band. It was comfortable—I actually forgot I was wearing monitoring equipment after the first day. I could shower, exercise, sleep normally. It was truly non-intrusive."
Joseph wore the garment for 14 consecutive days, living his normal life:
- Working full days at his office
- Attending his son's graduation
- Walking, sleeping, and yes—showering
- Going about daily activities without restriction
"For the first time in three years, I wasn't focused on my heart. I just lived my life—and the monitor did its job silently in the background."
Finally, An Answer
On day 9 of monitoring, Joseph's report revealed what years of testing had missed:
Clinical Findings:
- Multiple episodes of atrial fibrillation detected
- Longest episode: 4 hours 23 minutes
- AFib burden: 8.3% of monitoring period
- Episodes predominantly occurred during sleep
- Heart rate during AFib episodes: 110-140 bpm
"When my cardiologist called with the results, I felt relieved," Joseph says. "Not because I was scared—I was relieved. Finally, I had an answer. Finally, I knew I wasn't imagining things."
Treatment & Prevention
With a confirmed AFib diagnosis, Joseph's healthcare team could take action:
Immediate Steps:
- Started on anticoagulation therapy to prevent stroke
- Prescribed rate control medication
- Scheduled for follow-up echocardiogram
- Referred to electrophysiologist for long-term management options
Risk Assessment: Joseph's CHA2DS2-VASc score indicated elevated stroke risk. Without anticoagulation, his annual stroke risk was estimated at 4.5%. With appropriate medication, this risk dropped to less than 1%.
"My doctor told me that every year I went undiagnosed, I was at significant risk of stroke," Joseph reflects. "The 14-day monitor didn't just find my arrhythmia—it potentially saved me from a stroke."
Understanding Intermittent AFib
Atrial fibrillation is the most common sustained cardiac arrhythmia, affecting an estimated 350,000 Canadians. But not all AFib is constant—many patients experience paroxysmal AFib, which comes and goes unpredictably.
Types of Atrial Fibrillation:
- Paroxysmal AFib: Episodes that start and stop on their own, typically lasting less than 7 days
- Persistent AFib: Continuous episodes lasting more than 7 days, requiring intervention to restore normal rhythm
- Permanent AFib: Ongoing AFib where rhythm control is no longer pursued
Why Paroxysmal AFib is Hard to Catch:
- Episodes may occur only every few days or weeks
- Symptoms often resolve before medical evaluation
- Traditional 24-48 hour monitoring may miss sporadic events
- Patients may be asymptomatic during some episodes
The Statistics:
- Up to 40% of AFib cases are paroxysmal
- Studies show 24-hour Holter monitoring misses up to 50% of paroxysmal AFib
- Extended monitoring (7-14 days) increases detection rates by 2-3x
- Many strokes are the first sign of previously undetected AFib
Why Detection Matters
Atrial fibrillation increases stroke risk by approximately 5x. When the heart's upper chambers fibrillate rather than contract normally, blood can pool and form clots. If a clot travels to the brain, it causes a stroke.
AFib-Related Strokes:
- Account for approximately 15-20% of all strokes
- Tend to be more severe than strokes from other causes
- Have higher mortality and disability rates
- Are largely preventable with appropriate anticoagulation
The Prevention Opportunity:
For patients like Joseph, early detection enables preventive treatment:
- Anticoagulation reduces stroke risk by 60-70%
- Rate control improves symptoms and quality of life
- Rhythm control options may restore normal heart rhythm
- Lifestyle modifications can reduce AFib burden
"If I had suffered a stroke before getting diagnosed, I might not be here telling this story," Joseph says. "The 14-day monitor caught something that three years of traditional testing missed."
Could This Be You?
If you experience symptoms similar to Joseph's, you may benefit from extended cardiac monitoring:
Warning Signs to Discuss with Your Doctor:
- Heart palpitations or fluttering sensations
- Irregular heartbeat that comes and goes
- Unexplained fatigue or shortness of breath
- Episodes of rapid heart rate
- Dizziness or lightheadedness
- Previous "normal" cardiac tests despite ongoing symptoms
Who Should Consider Extended Monitoring:
- Patients with recurrent unexplained palpitations
- Those with previous 24-hour Holters that were normal but symptoms persist
- Individuals with risk factors for AFib (age, hypertension, diabetes)
- Patients who have experienced cryptogenic stroke
- Anyone concerned about intermittent cardiac symptoms
Taking Action:
- Talk to your doctor about your symptoms and concerns
- Ask about extended monitoring options covered by OHIP
- Find a participating clinic near you using our clinic locator
- Get fitted for comfortable, 14-day continuous monitoring
- Get answers that can protect your health
Joseph now manages his AFib with medication and regular monitoring. He has returned to his normal activities, including hockey with his friends. "For the first time in years, I'm not afraid of my heart," he says. "I know what's happening, and I know it's being managed."
If Joseph's story resonates with you, don't wait. Talk to your doctor about extended cardiac monitoring today.
