ECG ‘most useless test’to detect heart risk, say top cardiac experts

For decades, millions have relied on the ECG — or electrocardiogram — to gauge heart health. But leading cardiac surgeons now say this widely used test may offer a false sense of security.

“ECG is the most useless test for detecting heart disease,” declared Dr Ramakanta Panda, a top cardiac surgeon, on a recent podcast. “It only shows changes when you are in pain or have had a previous heart attack. If a patient has a critical block but no symptoms, an ECG won’t reveal it. To truly assess heart disease risk, a stress test is far more effective.”

Other experts echo this warning. “An ECG measures the electrical activity of a resting heart,” said Dr Saumya Sekhar Jenasamant, Consultant Cardiothoracic & Vascular Surgeon at KIMS Hospitals, Thane. “While it can detect rhythm problems or past heart attacks, it won’t indicate reduced blood flow if the patient isn’t currently experiencing distress.”

Stress test: Uncovering hidden threats

A stress test — also called a treadmill test — evaluates how the heart performs under physical exertion. “Unlike an ECG, which observes the heart at rest, a stress test reveals how it responds when it has to work harder,” explained Dr Rahul Gupta, Director – Cardiologist at Gleneagles Hospital, Mumbai.

Typically conducted while walking on a treadmill or cycling on a stationary bike, the test exposes blockages in coronary arteries that may go unnoticed at rest. Patients may experience changes in ECG tracings, chest pain, shortness of breath, or fatigue during the test, providing early warning signs of heart disease.

“This makes the stress test invaluable for detecting early heart problems, especially in people experiencing chest discomfort or breathlessness during exertion,” said Dr Gupta.

Who should take the test?

Individuals with diabetes, high blood pressure, elevated cholesterol, a history of smoking, or a family history of heart disease are prime candidates, according to Dr Jenasamant. It’s also recommended for those reporting unexplained exertional chest pain, shortness of breath, or reduced exercise tolerance, and for athletes or pre-surgical evaluations.

Important considerations

Stress tests are safe under medical supervision, but not everyone should undergo them. “A doctor must evaluate age, symptoms, and medical history before recommending a stress test. For some patients, advanced imaging tests may be more appropriate,” said Dr Jenasamant.

Dr Gupta cautions that the stress test is not infallible. It can miss very early disease or yield false positives, so doctors often combine it with other diagnostics for a comprehensive assessment.

Why early detection matters

Heart disease often develops silently. “By identifying reduced blood flow early, physicians can intervene with lifestyle changes, medications, or additional tests, potentially preventing catastrophic events like heart attacks,” said Dr Jenasamant.

For patients seeking an accurate picture of their heart health, experts agree: relying solely on an ECG may be risky. A stress test could be the key to uncovering hidden threats before it’s too late.