An electrocardiogram (EKG or ECG) and an echocardiogram (echo) are tests that help find problems with the heart muscle, valves, or rhythm. You may need 1 or both of these tests before starting some cancer treatments, like certain chemotherapy or a bone marrow/stem cell transplant. Some people may need other heart tests, too. They can include cardiac magnetic resonance imaging (MRI), a cardiac stress test, or a multigated acquisition (MUGA) scan.
Doctor may also use an EKG and/or echo during and after cancer treatment to look for possible heart damage caused by cancer treatment. Long-term side effects related to the heart, or late effects, may occur months or years after treatment. People who may need an EKG and/or echo after cancer treatment include:
People who had radiation therapy to the chest.
People who had a bone marrow/stem cell transplant.
People who have had certain types of chemotherapy.
How does chemotherapy affect the heart?
Some types of chemotherapy, such as anthracyclines, may damage the heart during cancer treatment. They include daunorubicin (Cerubidine, Rubidomycin), doxorubicin (Adriamycin), and epirubicin (Ellence). Other drugs used to treat cancer, such as trastuzumab (Herceptin), can also cause heart problems.
Sometimes, heart damage from these drugs cause a condition called congestive heart failure (CHF). CHF occurs when the heart does not pump enough blood to the rest of the body. People with CHF may have swollen hands and feet, shortness of breath, dizziness, and an irregular heartbeat. But the heart damage is often mild and can only be seen on an echo. Learn more about heart problems from cancer treatment.
How does an EKG work?
An EKG is a painless test that checks your heart’s function without being invasive. It records the electrical activity of the heart as wavy lines on a piece of paper.
You may need an EKG to check for:
Damage to heart muscle and tissue
Changes in the thickness of the muscle in the heart chamber walls
Chemical or electrolyte imbalances in the body
How does an echocardiogram work?
An echo is an ultrasound of your heart. Ultrasounds use high-frequency sound waves to take a picture of organs inside the body. A wand-like device called a transducer sends out sound waves. Then, the sound waves “echo” back. Like an EKG, the test is painless and not invasive.
You may need an echo before, during, or after cancer treatment to check for:
Blood clots in the heart’s vessels
Damage from previous heart attacks
Problems with heart valves
How well the heart pumps blood
Who does my EKG or echo?
These tests are done at a doctor's office or at a hospital. Nurses or medical technicians often perform an EKG. Sonographers, who are specially trained to use ultrasound machines, often perform an echo. A doctor then reviews the test results and decides what they mean.
Getting ready for an EKG or echo
When you schedule an EKG or echo, the office or hospital staff will tell you how to prepare. Be ready to talk about the following topics:
Your medications. Before having an EKG or echo, tell your health care team about all the medications you take. Ask whether you should take them on the day of the test because some medicines can affect the results.
Insurance and cost. If you are concerned about the cost of your EKG or echo, find out from your insurance provider what costs it will cover beforehand. Ask how much of the cost you will have to pay out of pocket.
Eating and drinking. You usually do not need to restrict your food or drink intake before your EKG or echo. However, if you are having an uncommon test called a transesophageal echo (TEE), guidance is different. In this type of echo, the ultrasound device is placed at the end of a thin, flexible tube. This tube goes through the mouth and down into the esophagus. You cannot eat or drink for several hours before a TEE.
What to wear. You will need to remove your clothing from the waist up during your EKG or echo. Wear a top that is easy to remove. Avoid using lotions or powders on the skin of your chest before the exam. You will also be asked to remove any jewelry before the exam.
What happens during an EKG or echocardiogram?
An EKG takes about 5 to 10 minutes to complete. During an EKG, a nurse or medical technician will place stickers called leads or electrodes on your chest. Then, they will connect wires to them. These leads collect details about your heart’s electrical activity. Normal activity is when the heart has 60 to 100 beats per minute and a normal rhythm and wave pattern. You will need to stay still during the test. You may also need to hold your breath for some of the time or lie flat on your back. This will help get a better reading from the machine.
An echo takes about 30 minutes to 1 hour to complete. During an echo, you will lie on your side on a table and be asked to stay still. The ultrasound technician will apply a small amount of gel to your chest. Then they will move the wand-like transducer around your chest to create pictures of your heart.
After either test, you can go back to your normal activities, including driving.
Questions to ask your health care team
Before having an EKG or echo, you may want to ask these questions:
Why do you think I should have an EKG or echo?
What do I need to do to prepare?
Who will perform the test?
What will the test show?
What will happen if I do not have this test?
When will I find out the results?
Who will explain the results to me?
If my results are not normal, what is the next step?