Electrocardiogram (ECG)

An electrocardiogram (ECG) is a simple test that can be used to check your

heart's rhythm and electrical activity.

Sensors attached to the skin are used to detect the electrical signals produced by your
heart each time it beats.

These signals are recorded by a machine and are looked at by a doctor to see if they're
unusual.

An ECG may be requested by a heart specialist (cardiologist) or any doctor who thinks

you might have a problem with your heart, including your GP.

The test can be carried out by a specially trained healthcare professional at a hospital, a
clinic or at your GP surgery.

Despite having a similar name, an ECG isn't the same as an echocardiogram, which is
a scan of the heart.

When an ECG is used

An ECG is often used alongside other tests to help diagnose and monitor conditions
affecting the heart.

It can be used to investigate symptoms of a possible heart problem, such as chest

pain, palpitations (suddenly noticeable heartbeats), dizziness and shortness of breath.

An ECG can help detect:

 arrhythmias – where the heart beats too slowly, too quickly, or irregularly

 coronary heart disease – where the heart's blood supply is blocked or
interrupted by a build-up of fatty substances
 heart attacks – where the supply of blood to the heart is suddenly blocked
 cardiomyopathy – where the heart walls become thickened or enlarged
A series of ECGs can also be taken over time to monitor a person
already diagnosed with a heart condition or taking medication known to
potentially affect the heart.
How an ECG is carried out

There are several different ways an ECG can be carried out. Generally, the test involves
attaching a number of small, sticky sensors called electrodes to your arms, legs and
chest. These are connected by wires to an ECG recording machine.

You don't need to do anything special to prepare for the test. You can eat and drink as
normal beforehand.

Before the electrodes are attached, you'll usually need to remove your upper clothing,
and your chest may need to be shaved or cleaned. Once the electrodes are in place,
you may be offered a hospital gown to cover yourself.

The test itself usually only lasts a few minutes, and you should be able to go home soon
afterwards or return to the ward if you're already staying in hospital.

Types of ECG

There are 3 main types of ECG:

 a resting ECG – carried out while you're lying down in a comfortable position

 a stress or exercise ECG – carried out while you're using an exercise bike or
treadmill
 an ambulatory ECG (sometimes called a Holter monitor) – the electrodes are
connected to a small portable machine worn at your waist so your heart can be
monitored at home for 1 or more days
The type of ECG you have will depend on your symptoms and the heart problem
suspected.

For example, an exercise ECG may be recommended if your symptoms are

triggered by physical activity, whereas an ambulatory ECG may be more suitable if
your symptoms are unpredictable and occur in random, short episodes.

You can also get a small, portable device with sensors you place your fingers on to
get a heart rhythm reading. You can view the reading in an app on your smartphone
or tablet. The device can be used to detect atrial fibrillation in people who have been
referred for ECG monitoring.

Getting your results

An ECG recording machine will usually show your heart rhythm and electrical activity as
a graph displayed electronically or printed on paper.
For an ambulatory ECG, the ECG machine will store the information about your heart
electronically, which can be accessed by a doctor when the test is complete.

You may not be able to get the results of your ECG immediately. The recordings may
need to be looked at by a specialist doctor to see if there are signs of a possible
problem. Other tests may also be needed before it's possible to tell you whether there's
a problem.

You may need to visit the hospital, clinic or your GP a few days later
to discuss your results with a doctor.

Are there any risks or side effects?

An ECG is a quick, safe and painless test. No electricity is put into your body while it's
carried out.

There may be some slight discomfort when the electrodes are removed from your skin –
similar to removing a sticking plaster – and some people may develop a mild
rash where the electrodes were attached.

An exercise ECG is performed under controlled conditions. The person carrying out the
test will carefully monitor you, and they’ll stop the test if you experience any symptoms
or start to feel unwell.
Arrhythmia

Arrhythmias or heart rhythm problems are experienced by more than 2 million

people in the UK. Most people with an abnormal heart rhythm can lead a normal
life if it is properly diagnosed.

The main types of arrhythmia are:

 atrial fibrillation (AF) – this is the most common type, where the heart

beats irregularly and faster than normal
 supraventricular tachycardia – episodes of abnormally fast heart rate at rest
 bradycardia – the heart beats more slowly than normal
 heart block – the heart beats more slowly than normal and can cause people to
collapse
 ventricular fibrillation – a rare, rapid and disorganised rhythm of heartbeats that
rapidly leads to loss of consciousness and sudden death if not treated
immediately
 Arrhythmias can affect all age groups, but atrial fibrillation is more common in
older people. Drinking alcohol in excess or being overweight increases your
likelihood of developing atrial fibrillation.

You may also be at risk of developing an arrhythmia if your heart tissue is damaged
because of an illness – for example, if you have had a heart attack or have heart
failure, or if you have had severe coronavirus (COVID-19).

Atrial fibrillation is a common cause of stroke. Having atrial fibrillation means your
risk of stroke is 5 times higher than for someone whose heart rhythm is normal.

Certain types of arrhythmia occur in people with severe heart conditions, and can
cause sudden cardiac death. This kills 100,000 people in the UK every year. Some
of these deaths could be avoided if the arrhythmias were diagnosed earlier.

Common triggers for an arrhythmia are viral illnesses, alcohol, tobacco, changes in
posture, exercise, drinks containing caffeine, certain over-the-counter and
prescribed medicines, and illegal recreational drugs.
Preventing arrhythmias

It is not always possible to prevent an arrhythmia developing, although a healthy

lifestyle can lower your risk of developing a heart condition.

Treatment aims to prevent future episodes. You can also make lifestyle changes so you
avoid some of the triggers for your heart rhythm problem.

Your heart's electrical system

The heart's rhythm is controlled by electrical signals. An arrhythmia is an abnormality of the

heart's rhythm. It may beat too slowly, too quickly, or irregularly.

These abnormalities range from a minor inconvenience or discomfort to a potentially fatal

problem.

Symptoms of arrhythmias

Symptoms of arrhythmias include palpitations, feeling dizzy, fainting and being short of

breath, although having these symptoms does not always mean you have a heart
rhythm problem.

Arrhythmia Alliance's heart rhythm checklists can help you gather information to discuss

with your GP if you have any of these symptoms.

Diagnosing arrhythmias

If your symptoms persist or there's a history of unexplained sudden death in your family,
it's important for your GP to refer you to a heart specialist (a cardiologist or
electrophysiologist who specialises in heart rhythm disorders).

The most effective way to diagnose an arrhythmia is with an electrical recording of your
heart rhythm called an electrocardiogram (ECG). If the ECG doesn't find a problem, you
may need further monitoring of your heart.

This may involve wearing a small portable ECG recording device for 24 hours or longer.
This is called a Holter monitor or ambulatory ECG monitoring. Some people might be
asked to wear an ECG monitor for up to 14 days.
If your symptoms seem to be triggered by exercise, an exercise ECG may be needed to
record your heart rhythm while you are using a treadmill or exercise bike.

You should request a copy of your ECG. Take it with you to see the cardiologist or heart
rhythm specialist and always keep a copy for future use.

Other tests used in diagnosing arrhythmias include:

 cardiac event recorder – a device to record occasional symptoms over a period

of time whenever you have them
 electrophysiological (EP) study – a test to locate problems with the electrical
signals in your heart by passing soft wires up a vein in your leg and into your
heart while you are sedated
 echocardiogram (echo) – an ultrasound scan of your heart

Treatment for arrhythmias

How your arrhythmia will be treated will depend on whether it is a fast or slow
arrhythmia or heart block. Any underlying causes of your arrhythmia, such as heart
failure, will need to be treated as well.

The treatments used for arrhythmias include:

 medicine – to stop or prevent an arrhythmia or control the rate of an arrhythmia

 electrical cardioversion – a treatment that uses electricity to shock the heart back
into a normal rhythm while you are anaesthetised or sedated
 catheter ablation – a keyhole treatment under local or general anaesthetic that
carefully destroys the diseased tissue in your heart that causes the arrhythmia
 pacemaker – a small device containing its own battery that is implanted in your
chest under local anaesthetic; it produces electrical signals to do the work of the
natural pacemaker in your heart to help it beat at a normal rate
 implantable cardioverter defibrillator (ICD) – a device similar to a pacemaker that
monitors your heart rhythm and shocks your heart back into a normal rhythm
whenever this is needed

Atrial fibrillation
Atrial fibrillation is a heart condition that causes an irregular and often
abnormally fast heart rate.
A normal heart rate should be regular and between 60 and 100 beats a minute when
you're resting.

You can measure your heart rate by checking your pulse in your wrist or neck.

Symptoms of atrial fibrillation

In atrial fibrillation, the heart rate is irregular and can sometimes be very fast. In some
cases, it can be considerably higher than 100 beats a minute.

This can cause problems including dizziness, shortness of breath and tiredness.

You may be aware of noticeable heart palpitations, where your heart feels like it's
pounding, fluttering or beating irregularly, often for a few seconds or, in some cases, a
few minutes.

Sometimes atrial fibrillation does not cause any symptoms and a person
who has it is completely unaware that their heart rate is irregular.

Coronary heart disease

Coronary heart disease (CHD) is a major cause of death in the UK
and worldwide. CHD is sometimes called ischaemic heart disease
or coronary artery disease.
Symptoms of coronary heart disease (CHD)

The main symptoms of coronary heart disease are:

 chest pain (angina)
 shortness of breath
 pain throughout the body
 feeling faint
 feeling sick (nausea)

But not everyone has the same symptoms and some people may not
have any before coronary heart disease is diagnosed.
Causes of coronary heart disease (CHD)

Coronary heart disease is the term that describes what happens when your heart's
blood supply is blocked or interrupted by a build-up of fatty substances in the coronary
arteries.

Over time, the walls of your arteries can become furred up with fatty deposits. This
process is known as atherosclerosis and the fatty deposits are called atheroma.

Atherosclerosis can be caused by lifestyle factors, such as smoking and regularly

drinking excessive amounts of alcohol.

You're also more at risk of getting atherosclerosis if you have conditions

like high cholesterol, high blood pressure (hypertension) or diabetes.
Diagnosing coronary heart disease (CHD)

If a doctor feels you're at risk of coronary heart disease, they may carry out a risk
assessment.

They'll ask you about your medical and family history and your lifestyle, and they'll take
a blood test.

Further tests may be needed to confirm coronary heart disease, including:

 a treadmill test
 a radionuclide scan
 a CT scan
 an MRI scan
 coronary angiography
Treating coronary heart disease (CHD)

Coronary heart disease cannot be cured but treatment can help manage the symptoms
and reduce the chances of problems such as heart attacks.

Treatment can include:

 lifestyle changes, such as regular exercise and stopping smoking

 medicines
 angioplasty – where balloons and stents are used to treat narrow heart arteries
  surgery
Recovering from the effects of coronary heart disease (CHD)

If you've had a heart attack, an angioplasty, or heart surgery, it's possible to get back to a normal
life.

Advice and support is available to help you deal with aspects of your life that may have been
affected by coronary heart disease.

Read more about recovering from the effects of coronary heart disease.

Preventing coronary heart disease (CHD)

You can reduce your risk of getting coronary heart disease by making some simple lifestyle
changes.

These include:

 eating a healthy, balanced diet

 being physically active
 giving up smoking
 controlling blood cholesterol and sugar levels
Keeping your heart healthy will also have other health benefits, such as helping reduce your risk
of stroke and dementia.

Heart attack
A heart attack (myocardial infarction or MI) is a serious medical emergency in
which the supply of blood to the heart is suddenly blocked, usually by a blood
clot.

A heart attack is a medical emergency. Call 999 and ask for an ambulance if

you suspect a heart attack.

A lack of blood to the heart may seriously damage the heart muscle and can be life
threatening.

Symptoms of a heart attack

Symptoms of a heart attack can include:

  chest pain – a feeling of pressure, heaviness, tightness or squeezing across your chest
 pain in other parts of the body – it can feel as if the pain is spreading from your chest to your
arms (usually the left arm, but it can affect both arms), jaw, neck, back and tummy
 feeling lightheaded or dizzy
 sweating
 shortness of breath
 feeling sick (nausea) or being sick (vomiting)
 an overwhelming feeling of anxiety (similar to a panic attack)
 coughing or wheezing
The chest pain is often severe, but some people may only experience minor pain, similar to
indigestion.

While the most common symptom in both men and women is chest pain, women are more likely
to have other symptoms such as shortness of breath, feeling or being sick and back or jaw pain.

Call 999 immediately if you think someone might be having a heart attack. The faster you act,
the better their chances.

Treating heart attacks

While waiting for an ambulance, it may help to chew and then swallow a tablet of aspirin
(ideally 300mg), as long as the person having a heart attack is not allergic to aspirin.

Aspirin helps to thin the blood and improves blood flow to the heart.

In hospital, treatment for a heart attack depends on how serious it is.

The 2 main treatments are:

 using medicines to dissolve blood clots

 surgery to help restore blood to the heart
Causes of a heart attack

Coronary heart disease (CHD) is the leading cause of heart attacks.

CHD is a condition in which the major blood vessels that supply the heart get clogged with
deposits of cholesterol, known as plaques.

Before a heart attack, 1 of the plaques bursts (ruptures), causing a blood clot to develop at the
site of the rupture.
The clot may block the supply of blood to the heart, triggering a heart attack.

Recovering from a heart attack

The time it takes to recover from a heart attack will depend on the amount of damage to your
heart muscle.

Most people can return to work after having a heart attack. Some people are well enough to
return to work after 2 weeks. Other people may take several months to recover. How quickly you
can go back to work depends on your health, the state of your heart and the type of work you do.

The recovery process aims to:

 reduce your risk of another heart attack through a combination of lifestyle changes (such as
eating a healthy diet), and medicines (such as statins), which help to lower blood cholesterol
levels
 gradually restore your physical fitness so you can resume normal activities (cardiac
rehabilitation)
Find out more about recovering from a heart attack

Complications of a heart attack

Complications of a heart attack can be serious and possibly life threatening.

These include:

 arrhythmias – these are abnormal heartbeats. 1 type is where the heart begins beating faster
and faster, then stops beating (cardiac arrest)
 cardiogenic shock – where the heart's muscles are severely damaged and can no longer contract
properly to supply enough blood to maintain many body functions
 heart rupture – where the heart's muscles, walls or valves split apart (rupture)
These complications can happen quickly after a heart attack and are a leading cause of death.

Many people die suddenly from a complication of a heart attack before reaching hospital or
within the 1st month after a heart attack.

The outlook often depends on:

 age – serious complications are more likely as you get older

 the severity of the heart attack – how much of the heart's muscle has been damaged during the
attack
  how long it took before a person received treatment – treatment for a heart attack should begin
as soon as possible
Find out more about complications of a heart attack

Preventing a heart attack

There are 5 main steps you can take to reduce your risk of having a heart attack (or having
another heart attack):

 smokers should quit smoking

 lose weight if you're overweight or obese
 do regular exercise – adults should do at least 150 minutes (2 hours and 30 minutes)
of moderate-intensity aerobic activity each week, unless advised otherwise by the doctor in
charge of your care
 eat a low-fat, high-fibre diet, including whole grains and at least 5 portions of fruit and
vegetables a day
 moderate your alcohol consumption

Cardiomyopathy

Cardiomyopathy is a general term for diseases of the heart muscle, where the walls of the
heart chambers have become stretched, thickened or stiff. This affects the heart's ability to
pump blood around the body.

The abnormal heart muscle seen in cardiomyopathy is not caused by blocked arteries in the heart
(coronary artery disease), high blood pressure (hypertension), disease of the heart valves
(valvular disease) or congenital heart disease.

Most types of cardiomyopathy are inherited and are seen in children and younger people.

Dilated cardiomyopathy

In dilated cardiomyopathy the muscle walls of the heart become stretched and thin, so they
cannot squeeze (contract) properly to pump blood around the body.

How serious is it?

If you have dilated cardiomyopathy, you're at greater risk of heart failure, where the heart fails to
pump enough blood around the body at the right pressure.
Heart failure typically causes shortness of breath, extreme tiredness and ankle swelling. Learn
more about the symptoms of heart failure.

There's also a risk of heart valve problems, an irregular heartbeat and blood clots. You'll need to
have regular appointments with a GP so the condition can be monitored.

Who's affected?

Dilated cardiomyopathy can affect both children and adults. 

The following can all play a role in the condition:

 inheriting a changed (mutated) gene that makes you more vulnerable to the condition
 an underlying medical condition
 uncontrolled high blood pressure
 an unhealthy lifestyle, such as a lack of vitamins and minerals in your diet, drinking too much
alcohol and using recreational drugs
 a viral infection that causes inflammation of the heart muscle
 a heart valve problem
 a disease of the tissues or blood vessels – such as granulomatosis with polyangiitis
(GPA), sarcoidosis, amyloidosis, lupus, polyarteritis nodosa, vasculitis or muscular dystrophy
 pregnancy – cardiomyopathy can sometimes develop as a complication of pregnancy
But for many people, the cause is unknown.

Medical Uses of ECG

The main goal of electrocardiography is to obtain information regarding the heart’s electrical
impulses. This means it can find evidence of past heart attacks or even any undiagnosed heart
disease. The medical uses of such information are very valuable and grant a deeper insight into
conditions like :
  Seizures
 Fainting
 Pulmonary embolism
 Cardiac dysrhythmias
 Myocardial infarction or heart attack
 Arrhythmia
 Deep vein thrombosis
 Ventricular hypertrophy
It also proves itself useful in applications such as:

 Biotelemetry of the patient

 The testing of Cardiac stress
 Diagnosis of structural heart diseases
 Monitoring the effects of heart medication
 Assessing the severity of the abnormalities in the electrolyte
 The monitoring of the form of anaesthesia that is involved
 CTA- Computed tomography angiography and also the MRA- Magnetic resonance
angiography of the heart
 The screening of Hypertrophic cardiomyopathy in adolescents as a part of the sports-related
deaths, such as sudden cardiac death.