16953 Electrocardiogram Ekg

Overview

An electrocardiogram — usually called an ECG in the UK and an EKG in the US — is a quick, painless test that records the electrical signals that make your heart beat. Small sticky patches are placed on your chest, arms and legs, and a machine draws a wave pattern on paper or a screen. Doctors use that pattern to see how fast and how regularly your heart is beating, and whether any part of the heart is working under strain. No electricity is sent into your body — the test only listens to the signals your heart makes on its own.

Very common. ECGs are done millions of times a year in GP surgeries, emergency departments and hospitals. They are one of the most routine heart tests there is.

Anyone can have an ECG, from newborn babies to people in their nineties. It is most often done for adults with chest pain, a fluttering heartbeat, dizziness or breathlessness, and as a check before surgery or when starting certain medicines.

Symptoms

Common symptoms

• Chest pain, tightness or pressure
• A fluttering, pounding or racing heartbeat (palpitations)
• Feeling short of breath, especially with activity
• Dizziness, light-headedness or feeling you might faint
• Actually fainting (passing out)
• Unusual tiredness or a feeling that your heart is missing beats
• Swelling in the ankles or legs, which can be a sign of heart strain

Symptoms in children

• Palpitations or a heartbeat that feels fast or irregular
• Fainting during exercise or sport
• Blue lips or skin, or breathlessness during feeding in babies
• A strong family history of heart rhythm problems, which may prompt a check even without symptoms
• A check before some types of surgery or before starting certain medicines

Symptoms in older adults

• Irregular heartbeat, which becomes more common with age
• Breathlessness or tiredness that is put down to 'just getting older'
• Dizziness or falls with no clear cause
• A check before surgery, or when starting a new medicine that can affect the heart
• Monitoring of a heart condition that is already known

Causes

Main causes

• Chest pain or suspected heart attack — an ECG is one of the first tests done
• Palpitations or an irregular pulse found by a doctor or nurse
• Breathlessness, dizziness or fainting with no obvious cause
• A known heart condition that needs regular monitoring
• A routine check before surgery or before starting certain medicines
• A family history of heart rhythm problems or sudden cardiac death at a young age
• Part of a general health check, an insurance or sports medical, or a workplace assessment

Risk factors

• High blood pressure
• Diabetes
• Smoking
• High cholesterol
• Being overweight
• A family history of heart disease, especially at a young age
• Long-term stress, heavy alcohol use or stimulant drugs
• Getting older — the risk of heart rhythm problems rises with age
• Some medical conditions, such as thyroid problems or sleep apnoea, which can affect the heart's rhythm

When to see a doctor

See a doctor urgently if:

• Chest pain or pressure, especially if it spreads or comes with sweating or nausea — call your local emergency number
• Fainting, or a collapse with no clear reason
• A racing or irregular heartbeat that does not settle, or comes with dizziness or breathlessness
• Severe breathlessness that is new or getting worse quickly
• Fluttering in the chest after starting a new medicine — speak to your doctor or pharmacist the same day

Book a routine appointment if:

• Palpitations that come and go but do not make you feel unwell
• Occasional dizziness or a feeling that your heart skips a beat
• A family history of heart rhythm problems or sudden cardiac death at a young age
• You have been advised to have an ECG before surgery or a new medicine
• You want to talk about whether a heart check is right for you

Diagnosis

The ECG is the test itself. A doctor or nurse looks at the wave pattern to judge your heart's rhythm, its rate, and how well the electrical signal moves through the heart muscle. They read the result together with your symptoms, your medical history, a physical examination, and often some blood tests. A single ECG is a snapshot, so if your symptoms come and go you may be offered a monitor to wear for longer.

Tests that may be done

• Resting 12-lead ECG — the standard test, done lying down with patches on your chest, arms and legs
• Ambulatory monitor (such as a Holter) — a small portable recorder worn for 24 hours or more to catch intermittent symptoms
• Event recorder or a smartwatch-style patch — worn for days or weeks and pressed or triggered when symptoms happen
• Exercise (stress) ECG — recorded while you walk or cycle on a machine to see how your heart copes with effort
• Blood tests, including heart markers and checks of thyroid, kidney and blood counts
• Echocardiogram — an ultrasound scan that shows the heart's shape, valves and pumping action
• Chest X-ray, or a referral to a heart specialist (cardiologist) for further tests if needed

What to expect at your appointment

You will usually lie on a couch, sometimes with your top removed and a gown provided. Small sticky patches are placed on your chest, arms and legs, and wires connect them to the machine. You need to lie still and breathe normally for a short time while the recording is made — usually under a minute of actual recording. The patches do not hurt; some people find them slightly cold or sticky to remove. You can go home straight afterwards and drive yourself if you feel well. Results may be ready the same day, or your GP may ring or write to you within a week or two.

Treatment

An ECG is not a treatment — it is a test that helps your doctor decide what, if anything, needs doing next. If the result is normal, you may need no treatment at all. If something is found, the treatment depends completely on what it is: it might be lifestyle advice, a medicine, a procedure, or simply a follow-up check in a few months.

Self-care at home

• Wear loose clothing that is easy to take off and put back on, and avoid body lotion or cream on the day
• Bring a list of all your medicines, including anything you buy over the counter and any supplements
• Write down when your symptoms happen and how long they last — this helps your doctor read the ECG
• Try to stay relaxed and warm on the day; shivering or an anxious, fast heartbeat can affect the tracing
• Ask when and how you will get your results, and who to contact if you have not heard back
• Keep taking your usual medicines unless your doctor tells you to stop

Medical treatments

Any treatment after an ECG is aimed at whatever the tracing shows. Broadly, this can include: lifestyle changes such as cutting down on alcohol, salt or smoking; medicines to steady the heart's rhythm, lower blood pressure or reduce strain on the heart; or procedures carried out by a heart specialist, such as a small device fitted under the skin to keep the heart beating regularly, or a procedure to correct an abnormal rhythm. Your own doctor will explain the options for your situation, including the benefits and drawbacks, and help you choose what suits you.

When is surgery considered?

Surgery is only ever needed for certain heart problems that an ECG might uncover, and most people who have an ECG never need an operation. If a serious rhythm problem or heart disease is found, a heart specialist will discuss whether a procedure or surgery could help.

Living with this condition

Having an ECG changes little in your daily routine. You go home the same day and can eat, work and drive as normal unless you have been told otherwise. If you are given a monitor to wear, keep it dry, avoid heavy exercise that makes you sweat a lot, and note down any symptoms with the time they happened so the recording can be matched to them.

Lifestyle tips

• Keep active — regular moderate activity such as walking or swimming supports heart health
• Cut down on smoking, and limit alcohol to the recommended levels
• Keep to a healthy weight and get your blood pressure and cholesterol checked when advised
• Get enough sleep, and tell your doctor if you snore heavily or feel very tired in the daytime
• Manage stress where you can — steady breathing, time outdoors and talking things through can help
• Limit caffeine if you notice it makes your heart race

Diet and exercise

A heart-friendly way of eating — plenty of vegetables, fruit, beans, whole grains, fish and nuts, with less salt, sugary drinks and processed food — supports heart health for most people. Aim for movement most days of the week. If you have been told you have a heart condition, ask your doctor or a physiotherapist what level of exercise is right for you; there are also structured heart rehabilitation programmes that many people find very helpful.

Mental health and emotional wellbeing

Being offered a heart test, or waiting for the result, can be worrying. Palpitations in particular can make people feel anxious, and anxiety itself can make the heart beat faster — a loop that is easy to get stuck in. It can help to tell your doctor how you are feeling, to avoid searching the internet late at night, and to talk to someone you trust. If worry is affecting your sleep, mood or daily life for more than a couple of weeks, please speak to your GP. If you ever feel you cannot cope, contact your local crisis line or emergency services.

Prevention

An ECG is a test, so it cannot be 'prevented' — but many of the heart problems it looks for can be made less likely. Keeping blood pressure and cholesterol in a healthy range, not smoking, staying active, drinking within limits and managing conditions like diabetes all lower the chance of heart trouble later on.

Screening programmes

ECGs are not routinely recommended for everyone with no symptoms, because a normal tracing can give false reassurance and an unusual pattern can lead to unnecessary worry and tests. They are usually done when there is a reason — symptoms, a family history, a check before surgery, or monitoring of a known condition. If you are wondering whether a heart check is right for you, ask your GP.

Complications

If left untreated

• The ECG itself has no risks — it is safe, painless and does not use radiation
• The main risk of any test is not acting on a problem that has been found, or not being checked when symptoms continue
• An untreated heart rhythm problem can, rarely, lead to fainting, stroke or heart failure, which is why follow-up matters
• A false result can occasionally cause worry or extra tests, which your doctor will talk through with you

Long-term outlook

For most people, an ECG brings good news or a clear answer, and any problem found can be managed. Heart tests today are quicker and gentler than ever, and finding something early usually means simpler treatment and a better outcome. If something does need attention, your medical team will walk through it with you step by step.

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