What is an electrocardiogram (EKG)?

The electrocardiogram (ECG or EKG) is a noninvasive test that is used to reflect underlying heart conditions by measuring the electrical activity of the heart. By positioning leads (electrical sensing devices) on the body in standardized locations, information about many heart conditions can be learned by looking for characteristic patterns on the EKG.

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How is an Electrocardiogram performed?

EKG leads are attached to the body while the patient lies flat on a bed or table. Leads are attached to each extremity (four total) and to six pre-defined positions on the front of the chest. A small amount of gel is applied to the skin, which allows the electrical impulses of the heart to be more easily transmitted to the EKG leads. The leads are attached by small suction cups, Velcro straps, or by small adhesive patches attached loosely to the skin. The test takes about five minutes and is painless. In some instances, men may require the shaving of a small amount of chest hair to obtain optimal contact between the leads and the skin.

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What is measured or can be detected on the EKG?

• The underlying rate and rhythm mechanism of the heart.
• The orientation of the heart (how it is placed) in the chest cavity.
• Evidence of increased thickness (hypertrophy) of the heart muscle.
• Evidence of damage to the various parts of the heart muscle.
• Evidence of acutely impaired blood flow to the heart muscle.
• Patterns of abnormal electric activity that may predispose the patient to abnormal cardiac rhythm disturbances.

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When is an EKG performed?

• As part of a routine physical examination or screening evaluation.
• As part of a cardiac exercise stress test.
• As part of the evaluation of symptoms of chest pain, shortness of breath, dizziness or fainting
• As part of the preoperative workup for surgery in patients who may be at an age where heart disease could potentially be present.

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What conditions may be diagnosed with an EKG?

• Abnormally fast or irregular heart rhythms.
• Abnormally slow heart rhythms.
• Abnormal conduction of cardiac impulses, which may suggest underlying cardiac or metabolic disorders.
• Evidence of the occurrence of a prior heart attack (myocardial infarction).
• Evidence of an evolving, acute heart attack.
• Evidence of an acute impairment to blood flow to the heart during an episode of a threatened heart attack (unstable angina).
• Adverse effects on the heart from various heart diseases or systemic diseases (such as high blood pressure, thyroid conditions, etc.).
• Adverse effects on the heart from certain lung conditions (such as emphysema, pulmonary embolus (blood clots to lung), etc.).
• Certain congenital heart abnormalities.
• Evidence of abnormal blood electrolytes (potassium, calcium, magnesium).
• Evidence of inflammation of the heart or its lining (myocarditis, pericarditis).

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What are the limitations of the EKG?

• The EKG is a static picture and may not reflect severe underlying heart problems at a time when the patient is not having any symptoms. The most common example of this is in a patient with a history of intermittent chest pain due to severe underlying coronary artery disease. This patient may have an entirely normal EKG at a time when he or she is not experiencing any symptoms. In such instances, the EKG as recorded during an exercise stress test may reflect an underlying abnormality while the EKG taken at rest may be normal.
• Many abnormal patterns on an EKG may be non-specific, meaning that they may be observed with a variety of different conditions. They may even be a normal variant and not reflect any abnormality at all. These conditions can often be sorted out by a physician with a detailed examination, and occasionally other cardiac tests (for example, echocardiogram, exercise stress test).
• In some instances, the EKG may be entirely normal despite the presence of an underlying cardiac condition that normally would be reflected in the EKG. The reasons for this are largely unknown, but it is important to remember that a normal EKG does not necessarily preclude the possibility of underlying heart disease. Furthermore, a patient with heart symptoms can frequently require additional evaluation and testing.

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