ECG (Electrocardiogram) in Abbottabad

An ECG, or electrocardiogram, records the electrical activity your heart produces with every beat. Ten sticky electrodes on the chest, arms and legs pick up those signals from the skin and the machine prints them as a tracing. It takes about ten seconds to record, costs less than any other heart test, and is the starting point for nearly every cardiac assessment.

Dr. Muhammad Ali Khan, Consultant Cardiologist in Abbottabad, reads the tracing himself alongside your symptoms and any earlier ECGs you bring, rather than relying on the interpretation the machine prints at the top of the page.

Who needs an ECG?

Almost everyone who sees a cardiologist, at least once.

It is the first test for chest pain or tightness, for palpitations, for fainting or near-fainting, and for breathlessness that might be cardiac. It is also done routinely in situations where nothing is currently wrong: before an operation, when starting certain medicines that affect heart rhythm, when high blood pressure has been present for years, and as a baseline in people with diabetes or a strong family history of early heart disease.

The European Society of Cardiology places a twelve-lead ECG at the front of the assessment pathway for suspected acute coronary syndromes, which is why any hospital anywhere will do one within minutes of a patient arriving with chest pain.

There is a second reason it gets done so often, and it is quietly the most useful one. A normal ECG recorded while you are well is worth having on file. Years later, when something does happen, a cardiologist comparing the new tracing against your old one can see a change that neither tracing alone would reveal.

How is an ECG done?

You lie on a couch with your chest, forearms and lower legs accessible.

Ten electrodes go on: six across the chest in set positions, and one on each arm and leg. They are small sticky pads with a little gel underneath. If chest hair prevents contact, a few small patches are shaved. The technician may ask you to lie flat, stay still and breathe normally for a few seconds, because talking, shivering or moving puts electrical noise from your muscles onto the tracing.

The recording itself takes around ten seconds. The machine prints twelve different views of the same heartbeat, taken from twelve angles, which is why it is called a twelve-lead ECG. Those angles are what let a cardiologist work out not just that something is wrong but which part of the heart it involves.

The whole appointment, from lying down to walking out with the strip in your hand, is usually under ten minutes.

How do I prepare for an ECG?

Barely at all, which surprises people.

• Do not fast. Eat and drink as normal.
• Take your usual medicines, including heart and blood pressure tablets, unless a doctor has specifically told you otherwise.
• Wear something that opens at the front. A shalwar kameez that has to come off over the head is inconvenient on a couch.
• Skip oil, lotion or cream on the chest that morning. Electrodes do not stick through it.
• Bring every previous ECG you own, even old ones from other hospitals.

That last point is the one people ignore and the one that changes the reading most often.

What do the results mean?

The tracing answers four separate questions.

The word patients dread on the report is "abnormal". It is worth knowing that the machine prints its own automated interpretation, and that interpretation is often wrong, particularly in young people, thin people and people of South Asian build. A cardiologist reading the actual tracing next to your symptoms reaches a different conclusion surprisingly often.

What an ECG cannot tell you

This matters as much as what it can, because a normal ECG reassures people more than it should.

An ECG does not show the inside of your coronary arteries. A significant narrowing can sit there silently while the ECG looks entirely normal, because the artery only causes electrical changes once the muscle it supplies is actually short of blood. That is the whole reason stress testing exists: an ETT or a stress echocardiogram records the heart while it is working hard, and an angiography looks directly into the arteries.

It also does not measure pumping strength or show the valves. That is an echocardiogram. And it only covers the ten seconds it recorded, so a rhythm problem that comes in bursts will very likely be missed, which is what Holter monitoring is for.

Most importantly: a normal ECG does not rule out a heart attack. If the pain is convincing, the test is repeated and a troponin blood test is added, because damaged heart muscle releases troponin into the blood even when the electrical picture stays unremarkable. The page on chest pain evaluation sets out how the whole assessment fits together, and there is more on reading your own paperwork in what your ECG and echo report actually say.

How much does an ECG cost in Abbottabad?

An ECG is the least expensive cardiac test available, which is part of why it is used so widely.

The charge depends on the facility recording it and on whether a cardiologist issues a formal written report or reads the tracing as part of your consultation. Confirm the current figure with the facility when you book. TODO: confirm current ECG charge at each clinic or partner facility

The consultation with Dr. Muhammad Ali Khan is Rs. 2,000 at either clinic, Monday to Saturday, or Rs. 2,500 for an online video consultation if you already have an ECG that needs interpreting.

Are there any risks?

None worth the name.

Nothing is injected, there is no radiation, and no electricity is passed into you. The machine only listens. The worst that happens is mild skin irritation where the electrodes were, or minor discomfort if chest hair had to be shaved. People with adhesive allergies should mention it beforehand so alternative electrodes can be used.

The World Health Organization lists the ECG among the basic diagnostic tools that should be available at every level of health service, precisely because it is cheap, safe and tells you a great deal in ten seconds.

If your symptoms are happening right now, though, this page is the wrong place to be. Crushing chest pain, severe breathlessness, cold sweats or collapse need 1122 or DHQ Hospital Abbottabad Emergency, not an appointment.