ECG at a checkup: do you need one, and what the results mean

Is a routine ECG recommended?

• Low risk of heart disease, no symptoms: the USPSTF recommends against screening with a resting or exercise ECG (grade D). It concluded with moderate certainty that the harms equal or exceed the benefits. (USPSTF, 2018)
• Intermediate or high risk, no symptoms: the evidence is insufficient to weigh benefits against harms (I statement). People at higher risk might have the most to gain, but those already at high risk should get intensive risk factor care whatever the ECG shows. (USPSTF, 2018)
• Some jobs: for people such as pilots and heavy equipment operators, where sudden illness could endanger others, reasons other than the person's own health may affect the decision to screen. (USPSTF, 2018)

Risk factors the USPSTF lists include older age, male sex, high blood pressure, current smoking, abnormal cholesterol levels, diabetes, obesity and physical inactivity, and it recommends that clinicians estimate 10-year risk with the Pooled Cohort Equations. (USPSTF, 2018) The heart screenings that are recommended, by age: heart screenings by age.

Why not test everyone? The USPSTF found that screening adults without symptoms leads to harms that are at least small and may be moderate, including unnecessary invasive procedures, overtreatment and labeling. In any risk group, an abnormal finding, true or false, can lead to invasive follow-up tests that carry risks such as radiation. (USPSTF, 2018) More on this: false positives and overdiagnosis.

Symptoms are different. An ECG is often the first test if you have signs of a heart condition, such as chest pain, a rapid or irregular heartbeat, shortness of breath, dizziness, tiredness or being less able to exercise. (MedlinePlus EKG test) Screening advice does not apply then; tell a doctor about the symptoms.

What other groups say

As summarized in the USPSTF statement: the American College of Physicians recommends against screening with a resting or stress ECG in adults at low risk without symptoms; the American Academy of Family Physicians (2012) recommended against ECG screening in people at low risk without symptoms; the American College of Preventive Medicine recommends against routine screening with a resting or exercise ECG in the general adult population; and the American College of Cardiology says an exercise ECG is rarely appropriate in adults at low risk, may be appropriate at intermediate risk and is appropriate at high risk. (USPSTF, 2018)

Where they differ: MedlinePlus says an EKG is not generally used to screen people without symptoms unless they have an increased risk of heart disease, (MedlinePlus EKG test) and NHLBI says you may have one as part of a routine exam to screen for heart disease, (NHLBI heart tests) while the USPSTF recommends against it at low risk and finds the evidence insufficient at higher risk. (USPSTF, 2018) Other tests the USPSTF advises against for people without symptoms: screening tests you may not need.

The Welcome to Medicare visit

The federal rules for the one-time Welcome to Medicare preventive visit, within the first 12 months of Part B, include education, counseling and referral, with a brief written plan such as a checklist, for obtaining an electrocardiogram, as appropriate. (42 CFR 410.16) Medicare.gov describes the visit as a review of your history and a written plan of the screenings and other preventive services you need, not a full physical exam, and notes you may have to pay for extra tests done at the same visit. (Medicare.gov) Ask your provider what an ECG would cost you before it is done. More: Medicare preventive screenings and the Annual Wellness Visit vs a physical.

What the test is like

• You lie down. Small sticky patches called electrodes are put on your arms, legs and chest, and some hair may be shaved or clipped so they stick. Wires connect them to a machine that turns the heart's signals into wavy lines. (MedlinePlus encyclopedia ECG)
• You lie still while the recording is made, which takes only a few minutes. Being relaxed and warm matters, because movement, even shivering, can change the results. (MedlinePlus EKG test) (MedlinePlus encyclopedia ECG)
• It is painless and no electricity is sent through your body. The patches may feel cold, and in rare cases the skin gets a rash or irritation where they were. (MedlinePlus encyclopedia ECG)
• To prepare: tell your provider about all the medicines and supplements you take, since some can affect the results, but do not stop any unless your provider tells you to. Do not exercise or drink cold water just before the test. (MedlinePlus EKG test) (MedlinePlus encyclopedia ECG)
• An ECG done while you exercise is called a stress test. (MedlinePlus encyclopedia ECG)

Common terms on an ECG report

These are general meanings only. Your health care provider reviews the tracing and the results. (MedlinePlus encyclopedia ECG)

Why an abnormal-looking ECG often needs no action

• An ECG cannot diagnose a heart condition on its own. Your provider uses it with your history and other tests, and you may need more tests before any diagnosis. (MedlinePlus EKG test)
• Some findings are common in healthy people. First-degree heart block occurs in some healthy people, most often young ones, (MedlinePlus heart block) and extra beats are common in adults; often no further testing is needed when the ECG is otherwise normal and symptoms are not severe or worrying. (MedlinePlus ectopic heartbeat)
• Many people with a conduction disorder such as a bundle branch block have no symptoms, and with very mild or no symptoms, treatment may not be needed. (NHLBI conduction disorders)
• The reverse is also true: an ECG is a snapshot of a short time, a heart problem may not show up on it, and some heart conditions never produce specific ECG changes. A normal ECG is not a guarantee. (MedlinePlus EKG test) (MedlinePlus encyclopedia ECG)

Your doctor decides what your result means for you. This page does not give diagnosis or treatment advice. If you were told a result was abnormal, see after an abnormal screening result for questions to ask.

Questions people ask

Should I get an ECG at my yearly checkup?

Not if you have no symptoms and a low risk of heart disease: the USPSTF recommends against screening with a resting or exercise ECG (grade D, 2018). For adults at intermediate or high risk it found the evidence insufficient to weigh benefits against harms (I statement), so the choice rests with you and your doctor. (USPSTF, 2018)

Why not just do an ECG to be safe?

The USPSTF found that screening adults without symptoms leads to harms that are at least small and may be moderate, including unnecessary invasive procedures, overtreatment and labeling. An abnormal result, true or false, can lead to further invasive tests that carry their own risks, including radiation. (USPSTF, 2018)

Does Medicare cover an ECG at the Welcome to Medicare visit?

The rules for the one-time Welcome to Medicare visit (42 CFR 410.16) include education, counseling and referral, with a brief written plan such as a checklist, for obtaining an electrocardiogram, as appropriate. Ask your provider and Medicare what applies to you before the test. (42 CFR 410.16) (Medicare.gov)

Does an ECG hurt?

No. It is painless and no electricity is sent through your body. The sticky patches may feel cold, and rarely the skin gets a rash or irritation where they were. (MedlinePlus encyclopedia ECG) (MedlinePlus EKG test)

My ECG report says "abnormal". Is something wrong with my heart?

Not necessarily. Some findings, such as first-degree heart block or occasional extra beats, are common in healthy people, and an ECG cannot diagnose a heart condition on its own. Your provider reads it with your symptoms, history and other tests. Your doctor decides what your result means for you. (MedlinePlus heart block) (MedlinePlus ectopic heartbeat) (MedlinePlus EKG test)

Related

• Heart screenings by age
• Coronary calcium score results
• Blood pressure readings: what they mean
• Annual physical tests by age
• Screening tests you may not need