ECG Vs ECHO: Difference between Electrocardiogram and Echocardiography

By Dr. Salil Shirodkar in Heart Institute

Apr 24 , 2023 | 8 min read


Introduction of ECGs and Echocardiograms

It might be scary to get a diagnosis of heart disease. However, ECGs and Echocardiograms are the two most common diagnostic tests used by physicians to analyze the condition of the heart and discover disorders that affect it. Understanding these tests might help make the procedure a little less scary and encourage you to consider heart-healthy lifestyle options.

The electrocardiogram (ECG) vs the echocardiogram (ECHO) are painless, non-invasive medical procedures. They help evaluate the heart's performance. When comparing ECG vs ECHO, an essential difference between ECG and ECHO is that an ECG will display the heart's electrical system, whereas the mechanical system of the heart can be seen clearly with an ECHO.

Electrocardiograms: what are they and how do they work?

Electrocardiograms, often called ECGs, are machines used by medical professionals to measure your heart's electrical activity.

  • Your heart produces an electrical impulse with each beat. This impulse passes throughout the heart and helps it pump blood
  • ECGs help doctors figure out if your heart's electrical activity is normal
  • An ECG is a waveform representation of your heart's electrical rhythm
  • A healthy heart's ECG report will have a uniform structure. An unhealthy heart will show irregular waveforms

How does an Echocardiogram work?

An echocardiogram (ECHO) conducts a live imaging test that doctors use to examine the heart's activity.

  • The test provides a real-time picture by producing an image of the heart and its valves through sound waves reflected off the patient's heart
  • An ECHO is similar to an ultrasound in that it produces a live image of the heart
  • An ECHO allows ph ysicians to see live footage of a beating heart to obtain vital information regarding heart health

Different Types of ECG

Cardiopulmonary exercise test (CPET)

CPET is a test that checks heart function at different levels of activity. This test is usually done to check the fitness of athletes or those who are about to begin an exercise program.

Exercise EKG (stress test)

Exercise EKG or stress test is done to see how the heart reacts to different levels of physical activity. This test is very similar to CPET, but since it is done under stress, it can be a dangerous test for some patients.

Holter monitor

A Holter monitor is a continuous ECG monitor that is worn by the patient for 24 hours. The test helps in detecting heart rhythm disorders, like atrial fibrillation and ventricular tachycardia. 

Resting 12-lead EKG

Resting 12-lead EKG is a test that tests the electrical activity of the heart. It is performed when the patient is relaxed, and it helps in detecting any abnormalities and is done usually as a routine checkup.

Signal-averaged electrocardiogram

Signal-averaged electrocardiogram (SAECG) is a test that is used to look at the electrical activity of the heart. It helps in detecting any abnormalities in the heart circuitry as well as any heart diseases.

What's an ECHO or Echocardiogram? 

An ECHO or echocardiography is a test that uses ultrasound to study the structure and function of the heart. It helps in checking the size, shape, and any abnormality present in the heart.

Different Types of ECHO

Transesophageal echocardiogram    

Transesophageal echocardiogram (TEE) is a medical imaging test that uses ultrasound to study the structure and function of the heart. The major use of this test is to find out any abnormality in the heart and detect any medical problems.

Transthoracic echocardiogram

Transthoracic echocardiogram (TTE) is a medical imaging test that uses ultrasound to study the structure and function of the heart. This is one of the most common types of ECHO and is used to check any heart abnormalities.

Stress echocardiogram

Stress echocardiogram is a test that uses ultrasound to study the structure and function of the heart in real-time. This test is commonly done on elite athletes to check for any signs of heart disease.

What are the Differences between ECG and ECHO?

  • A common test to examine the activity of your heart
  • A test to confirm or diagnose the symptoms and signs of a heart disease
  • Gives you a picture of the heart’s electrical system
  • Gives you a picture of the heart’s mechanical system
  • Provides information only about heartbeat rate or rhythm
  • Provides the functional data of the heart
  • The test takes 5 to 10 minutes only
  • The test takes almost 15 minutes

How are the ECGs and Echocardiogram Tests Done?

An electrocardiogram test normally takes between 5 and 10 minutes. First, the doctor places about 10 sticky pads on your chest, connecting them to the machine. The equipment will start tracking the electrical activity of your heart and generating an electrocardiogram.

The echocardiogram takes about 20 minutes to complete. The physician applies an ultrasound conductivity gel to get the required images and then moves the ultrasound probe over your chest

When do you need ECGs and ECHO?

ECGs are typical diagnostic procedures that are performed in the following situations:

  • When you are experiencing an irregular heartbeat (arrhythmia)
  • When you experience a heart attack or chest pain as a sign of coronary artery disease
  • If you have a history of a heart attack
  • To assess the efficacy of heart disease treatments such as pacemakers


You may need an ECHO in the following situations:

  • To ensure there are no problems with the heart's valves or chambers
  • To identify if cardiac conditions are the source of the problem or the symptoms
  • To detect congenital heart problems before birth

Differences in technique - ECG vs Echocardiogram

  • ECG requires placing painless electrodes capable of recording the heart's activity on the surface of the skin
  • 10-12 patches are placed on the chest, arms, and legs, which are then wired to a machine
  • The machine prints the electrical activity on paper for further analysis
  • The process takes 10 minutes and does not pose any risks to the patient's health or safety, including electric shocks
  • An ECG can also be performed while exercising to detect the effects of cardiac stress. This is commonly known as Cardiac Stress Test
  • An ECHO is a diagnostic procedure that produces images of the beating heart using sound waves
  • It uses typical ultrasound techniques like two-dimensional, three-dimensional, and Doppler. Transthoracic, transesophageal, and stress echocardiography are other viable methods
  • A transducer is attached to a monitor and used to record the heart's images
  • It is moved across the patient's chest by the doctor throughout the duration of the procedure
  • The treatment takes approximately 10 to 15 minutes

Differences in uses - ECG vs ECHO

  • An ECG monitors the heart's electrical activity and, as a result, gives details about the heart's pace, rhythm, and regularity
  • An ECG is a rapid screening procedure used to detect arrhythmias, heart muscle damage after a heart attack, the condition of any implanted device such as a pacemaker, congenital problems, and drug side effects
  • In addition to being part of a standard health examination, an ECG is performed before major surgery
  • Echocardiography shares information about the heart's size, shape, pumping ability, where and how much tissue damage is there, and how the heart's chambers and valves are functioning
  • It is primarily used to assess the state of the cardiac muscle following a heart attack
  • This testing method can detect infections in the heart's sac and valves
  • In addition, a colour Doppler echocardiogram provides an accurate analysis of the heart's blood flow

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Are there any side effects of ECGs and ECHO

  • An ECHO carries a negligible risk of adverse effects or problems
  • During a transesophageal electrocardiogram, a person may gag when the sonographer moves the tube down the throat. People may also experience a sore throat after the test
  • The transesophageal echocardiogram rarely causes major complications, such as injury to the throat, vocal cords, or oesophagus
  • An allergic reaction to local anaesthesia, sedative, and contrast dyes may occur during the examination
  • A person who takes sedatives is at risk of having their stomach contents enter their lungs. Therefore, the physician will instruct the individual to come to the treatment with an empty stomach to avoid this issue



ECG and ECHO are diagnostic tools that detect problems with the heart's muscles, valves, or rhythm. These tests are crucial for diagnosing the source of various heart problems. In addition, they are easy, non-invasive, and relatively inexpensive compared to other diagnostic techniques.

Frequently Asked Questions (FAQs)

1. Which is more accurate, ECG or Echo?

In an echocardiogram, an ultrasonic scan of the heart is used to make moving images that show the detailed structure and function of the heart. They are useful for assessing heart failure because this. Echo gives exact information regarding heart valve function. When assessing the heart's anatomy and function and comparing ECG vs. ECHO, Echo is far more precise than ECG.

2. Is ECG required when ECHO is normal?

Electrocardiograms are painless and non-invasive diagnostic tools for various common heart conditions. If the ECG results indicate a heart rhythm problem, you may require a second ECG or another test, including an echocardiogram. The treatment depends on the cause of your symptoms.

3. Can ECG readings be inaccurate?

Sometimes, ECGs find problems that don't exist. These are called "false positives." According to clinical studies, false positives are significantly more common than false negatives in ECG readings. The research of 500 patients reported ECG false positives between 77% and 82% and false negatives between 6% and 7%.

4. Can the ECHO identify heart blockage?

Echocardiograms can reveal the condition of your heart valves. They are able to determine how efficiently the heart is pumping. Even the pressures inside your heart's chambers can be determined through echocardiograms. Stress echocardiograms can detect coronary artery abnormalities. However, an echocardiogram cannot give information concerning heart artery blockages.

5. What is not detected in ECG?

Doppler ultrasound is used in conjunction with an echo to provide an image of the heart muscles and valves. ECG does not reveal valvular abnormalities. ECGs are incapable of detecting valvular abnormalities. However, an X-ray of the chest may identify such abnormalities.

6. Are ECG and echocardiogram the same thing?

Although ECG vs echocardiogram monitors the heart, they are specific tests. Using electrodes, an ECG detects abnormalities in the electrical impulses of the heart, whereas an echocardiogram uses ultrasound to check for anomalies in the heart's structure.

7. Is the result of an ECG accurate?

Understanding anything about the patient for whom an ECG was done could lead to a more critical assessment of rhythm, which could account for the cardiologist's greater accuracy in rhythm interpretation than the overreading cardiologist, who is missing important clinical information. An ECG is a good way to determine if someone has a different kind of heart disease, but it doesn't always find every heart problem.

8. Can an echocardiogram be wrong?

Congenital heart disease diagnostics rely heavily on echocardiograms. However, echocardiograms are unable to detect heart artery blockages.

9. Can anxiety alter the results of an echocardiogram?

Short-term anxiousness can affect ECG readings in persons without recognized anxiety or mental health conditions. Anxiety can cause premature ventricular contractions, a symptom of hyperactive sympathetic nerves. Anxiety might raise your heart rate, making it more difficult to capture images of echo.