Some people with cancer receiving chemotherapy may need to have an electrocardiogram (EKG or ECG) or an echocardiogram (also known as an echo test) during their cancer treatment. Some types of chemotherapy, such as anthracyclines, can damage heart tissue during cancer treatment. Examples of anthracyclines include daunorubicin (Cerubidine, Rubidomycin), doxorubicin (Adriamycin), and epirubicin (Ellence). Heart damage from anthracyclines can lead to arrhythmias (abnormal heart rhythms) or a weakening of the heart, resulting in congestive heart failure (CHF, weakness of the heart muscle that causes fluid buildup in the body). People with heart arrhythmias may experience lightheadedness, chest pain, and shortness of breath because the heart is not effectively pumping blood to the rest of the body. People with CHF may have symptoms such as shortness of breath, dizziness, and swollen hands or feet.

Before starting chemotherapy that may cause these heart problems, your doctor may want you to have an EKG or echocardiogram. These procedures, along with others such as a MUGA scan, will monitor your heart function and check for existing heart conditions. Survivors of childhood cancer who have had radiation therapy to the chest, spine, or upper abdomen; a bone marrow/stem cell transplantation, or chemotherapy with anthracyclines may also need an EKG or echocardiogram as part of their follow-up care.

About the procedures

EKG

An EKG is a painless, noninvasive test that checks your heart’s electrical function by recording the heart’s electrical activity with lines on a paper. The lines form waves on the paper, which show the electrical activity of different areas of the heart. An EKG may be performed to check for:

• Arrhythmias
  
  
• Damage to heart muscle and tissue
  
  
• Thickness of the heart walls
  
  
• Chemical or electrolyte imbalances in the body

How to prepare

No preparation is necessary before your EKG. Be sure to tell your doctor about any medications you are taking, because some may affect the results of the test.

What to expect

An EKG is performed as an outpatient procedure (usually by a nurse or medical technician), and you can leave the hospital or doctor’s office as soon as it is complete. Stickers (called leads or electrodes) are placed on your chest in several places and wires are connected to them. Once all the wires are connected, you will be asked to lie still while the technician prints a recording of your heart function. You may be asked to hold your breath, or to lay flat on your back so the technician can get a better reading from the machine. The test should take five to 10 minutes to complete. You can usually resume normal activities immediately after the EKG. A normal EKG result is when the heart is functioning at 60 to 100 beats per minute and shows a normal rhythm and wave pattern.

Echocardiogram

An echocardiogram is an ultrasound (sonogram) of your heart and is performed by a sonographer (medical professional who uses devices to produce diagnostic images). An echocardiogram uses sound waves that are transmitted to your heart. The sounds are echoed and returned through a wand-like device called a transducer. With the movement of the heart and the echoing of the sound waves, images can be taken of the heart. Like the EKG, it is painless and noninvasive, and only takes a few minutes. An echocardiogram is useful in evaluating heart function before, during, and after cancer treatment.

An echocardiogram may also be performed to check for:

• Blood clots in the blood vessels in the heart
  
  
• Previous heart attacks or conditions
  
  
• Tumors
  
  
• Infections
  
  
• Problems with heart valves

What to expect

No preparation is necessary before an echocardiogram. The technician will have you lie down on your side with your chest exposed. A small amount of gel will be applied to your chest and the transducer will be moved around to several places on your chest to show images of your heart.

Questions to ask the doctor

Before an EKG or echocardiogram, ask your doctor the following questions:

• Why are you recommending these procedures?
  
  
• Do I need to do anything to prepare for these procedures?
  
  
• Who will perform the procedures?
  
  
• What will the procedures show?
  
  
• What if I don’t have these procedures?
  
  
• Will I find out the results right away?
  
  
• Who will explain the results to me?
  
  
• If my results are abnormal, what is the next step?

More Information

Tests and Procedures

Late Effects of Childhood Cancer (Part II)

Additional Resources

National Heart, Lung, and Blood Institute: Electrocardiogram

MedlinePlus: Echocardiogram

Last Updated: July 27, 2009