ECG vs Echo vs TMT: Which Heart Test Do You Need?

In today’s fast-paced world, there has been an increase in cardiovascular disease due to a sedentary lifestyle. Cardiac diagnostic tests play an important role in the early detection, evaluation, and management of heart-related conditions. Among the most commonly used non-invasive investigations are the ECG, Echo, and the Treadmill test that provide valuable information about the structure, function, and performance of the heart. 

Keep reading to know how each of these tests works, why they are ordered, and what the results mean!

What Is an ECG (Electrocardiogram)?

An electrocardiogram (ECG or EKG) is a quick, simple, painless medical test done to check the heartbeat and record the electrical signals in the heart. Every heartbeat is triggered by electrical signals, and an ECG captures these signals to assess how well the heart is functioning.  It helps diagnose heart attacks, irregular heartbeats, called arrhythmias, and other cardiac conditions.

How does an ECG work?

An electrocardiogram is done in a medical office, hospital, ambulance or other emergency vehicle. The procedure is painless and usually takes only a few minutes.

• A member of your healthcare team may shave any hair on the area where the electrode patches are placed.
• You will lie down on an examining table, and up to 12 sticky patches, called electrodes, are attached to the chest and sometimes to the arms or legs. Wires connect these patches to a computer.
• The electrodes detect the electrical impulses that trigger each heartbeat. The signals are then transmitted to a machine, which displays them as wave patterns on a screen or paper.  
• Once the tracing is completed, the technician will disconnect the leads and remove the electrodes.

What ECG Can Detect?

An ECG may help detect

• Unusual fast heart rate, called tachycardia or an unusual slow heart rate called bradycardia.
• Irregular heartbeats, called arrhythmias
• A current or previous heart attack
• Heart muscle thickening or strain
• Conduction problems
• Effects of electrolyte imbalances
• Medication monitoring and management of overdose
• Cause of chest pain, including signs of blocked or narrowed heart arteries
• Heart structure changes, including an enlarged heart, congenital heart defects and other heart conditions
• Cardiac stress testing
• To see how an implanted pacemaker is working

When is an ECG recommended?

An ECG is done if you have

• Chest pain
• Dizziness, lightheadedness or confusion
• Palpitations, or fluttering heartbeat
• Fast pulse
• Shortness of breath
• Weakness or fatigue
• Reduced ability to exercise

It is also done during routine health check-ups, before surgery, to check how well a pacemaker and heart disease treatments are working. The American Heart Association recommend an ECG for those at low risk of heart disease, even if there are no symptoms. 

Read Also: Heart Diseases Myths vs Facts: What You Need to Know

What Is an Echocardiogram (Echo)?

An echocardiogram, also known as a heart ultrasound and heart sonogram, is a non-invasive imaging test that uses sound waves to create real-time pictures of the heart. It helps doctors examine the heart’s structure, function, and overall performance, including its ability to pump blood effectively.

How does Echo work?

An Echo is painless, safe, and involves no radiation. It is typically performed in a medical centre or hospital. 

• You will be changed into a hospital gown
• A healthcare professional will place a handheld device called a transducer on the chest after applying a special gel.
• The transducer sends soundwaves into the body, which bounce off the heart’s structure. These returning echoes are captured by the transducer and converted into real-time moving images of the heart on the screen.

The images help healthcare professionals to assess heart size, movement, pumping strength, and valve function.

What Echo Can Detect?

An echo may show

• Changes in heart size, including weakened or damaged heart valves, high blood pressure or other diseases
• Pumping strength
• Heart muscle damage or weakness
• Blood clots or fluid around the heart
• Detect heart valve disease (leakage or narrowing)
• Heart problems present at birth, called congenital heart defects

When is Echo recommended?

Cardiologists recommend echocardiograms to 

• Identify the cause of heart-related symptoms
• Confirm a diagnosis of heart conditions
• Assess the heart’s function
• Monitor existing valve disease
• Evaluate the heart before or after surgery

An echo may be advised if a person has

• Shortness of breath or fatigue
• Chest pain of unclear cause
• Heart murmurs
• Swelling in the legs or abdomen
• History of heart attack, heart failure, or valve disease

What Is a TMT (Treadmill Test)?

Treadmill stress testing (TMT), also known as a cardiac stress test or exercise stress test, is a commonly used diagnostic procedure that evaluates how well the heart performs under physical stress. It is used to identify heart problems that may not be noticeable when the body is at rest, as the heart requires more oxygen and blood flow during exercise.

It involves walking on a treadmill or pedalling on a stationary bike to monitor your heart’s activity.

How TMT Works?

The TMT test procedure is generally performed under controlled conditions, and the duration of the test may be predetermined by the treating doctor. 

• You may undergo a brief physical examination before the procedure. Small adhesive electrodes are placed on the patient’s chest to record the heart’s electrical signals. A pressure cuff is applied to monitor blood pressure at regular intervals. 
• It begins with walking slowly on the treadmill, and the pace of the treadmill is gradually increased at predetermined intervals to steadily raise the heart’s workload. This controlled increase allows doctors to observe how the heart responds to increasing physical demand.
• If the patient experiences any difficulties, the doctor may assist and decide to stop the test if necessary.
• After completing the test, the doctor may continue to monitor the patient’s heart rate and breathing for a short period. Abnormal results may indicate the presence of cardiac abnormalities.

What TMT Can Detect?

A treadmill test may help identify several heart-related conditions, including

• Reduced blood flow to the heart muscle
• Coronary artery disease is caused by narrowed or blocked arteries
• Abnormal heart rhythms (arrhythmias) triggered by exercise
• The heart’s ability to tolerate physical activity and overall cardiovascular fitness
• Effectiveness of cardiac medications or previous cardiac treatments

The test also helps doctors determine safe levels of physical activity and guide treatment or lifestyle recommendations.

When is TMT Recommended?

Treadmill testing is performed 

• When symptoms suggest myocardial ischemia, including chest discomfort, breathlessness, dizziness, palpitations, or unexplained fatigue.
• In patients experiencing acute or recurrent chest pain in patients
• To identify cardiac muscle or valve problems
• To evaluate the efficiency of blood pumping by the heart
• In individuals with risk factors for heart disease, including diabetes, hypertension, obesity, smoking, or a family history of cardiac problems.

ECG vs Echo vs TMT: Key Differences 

Parameter	ECG	Echo	TMT
Purpose	Records the electrical activity of the heart	Visualizes heart structure and function using ultrasound	Assesses heart performance during physical stress
Invasiveness	non-invasive	non-invasive	non-invasive
Why is it done?	To check heart rhythm and detect electrical problems	To see the heart’s structure and how well it pumps blood	To see how the heart functions during physical activity
Arrhythmias	Yes	Sometimes	Yes especially exercise-induced
What can it detect?	Irregular heartbeat, heart rate problems, signs of a past heart attack	Heart valve problems, heart muscle strength, and pumping ability	Reduced blood flow to the heart, exercise-related chest pain

Table: Key differences between Echocardiogram, Echo, and TMT

Which Heart Test Do You Need Based on Symptoms?

Different heart tests are recommended depending on your symptoms and what your doctor wants to evaluate. Each test provides unique information about your heart’s health. The different tests recommended are

• If you have palpitations or an irregular heartbeat, your healthcare provider may recommend an ECG. This test records the heart’s electrical activity and helps identify abnormal heart rhythms or heartbeat patterns. 
• If you feel shortness of breath, fatigue, or swelling in the legs, an Echo may be recommended tocreate images of the heart and show how well the heart is pumping blood. It may detect weak heart muscles or valve problems.
• If you experience chest pain during physical activity, A TMT test is usually recommended. This test checks how your heart performs when it is working harder and helps detect reduced blood flow to the heart muscle.
• If you have chest pain even at rest, your doctor may suggest an ECG along with further heart tests to rule out serious conditions, including a heart attack.
• If you have risk factors for heart disease, people with diabetes, high blood pressure, obesity, smoking habits, or a family history of heart disease may be advised to undergo a combination of tests to assess overall heart health.

However, only a qualified healthcare professional may decide which test or a combination of tests is right for you after evaluating your symptoms, medical history, and risk factors. 

Cost of ECG, Echo & TMT Tests

The cost of heart tests, including ECG, Echo, and TMT, may vary depending on several factors, including 

• Location of hospital or diagnostic center
• Type of test and technology used
• Doctor’s consultation and reporting charges
• Emergency or routine testing

An ECG is generally the most affordable of the three tests as it is quick, non-invasive and does not require advanced imaging equipment. An echo may cost more than an ECG as it uses ultrasound technology. A TMT is generally more expensive than an ECG but may be comparable to an Echo, as it involves continuous heart monitoring. 

Test	Typical range
ECG	200-800 INR
Echo	1000-3000 INR
TMT	1500-4000 INR

Table: Cost of ECG, Echo, and TMT in India

Conclusion

Heart tests, including ECG, Echo, and TMT, play an important role in assessing heart health,  identifying potential problems early, guiding timely treatment, and preventing serious complications. These tests are safe, non-invasive, and commonly recommended based on a person’s symptoms, medical history, and risk factors. 

If you experience symptoms, including chest pain, breathlessness, palpitations, or unexplained fatigue, you may book a consultation at Heart360 Care to support long-term heart health and improve patient outcomes. 

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