Medically Reviewed By: Dr Paul Lim – MBBS, M.Med (Int Med), MRCP (UK), FAMS (Cardiology)
Patient Guide

Echocardiogram vs ECG (What Is the Difference?)

An ECG records your heart’s electrical activity. An echocardiogram is an ultrasound scan of its structure. Two tests that sound alike, answering different questions. Not sure which one you need? Sit down with our friendly Dr Paul Lim, who will listen to you patiently and discuss your options with you.

Dr Paul Lim Chun Yih Senior Consultant Cardiologist & Electrophysiologist
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Side by Side

ECG vs Echocardiogram: The Differences

Both are painless, neither uses radiation, and both are commonly done at the same visit. What separates them is what they measure.

How an ECG and an echocardiogram differ across what they measure, how they are done, what they show, and what they cost
ECG (Electrocardiogram) Echocardiogram
What it measures The electrical signal that triggers each heartbeat. The structure of the heart and how it moves, using ultrasound.
What you experience Ten small electrodes are placed on your chest, arms and legs while you lie still. You lie on your left side while a probe with gel is moved across your chest.
How long it takes About 5 to 10 minutes. 20 to 45 minutes.
What it shows well Heart rate, rhythm, conduction delays, the pattern left by a previous heart attack, and strain from long-standing high blood pressure. Chamber size, wall thickness, valve function, pumping strength (ejection fraction), and fluid around the heart.
What it cannot tell you How well the heart is pumping, or whether the valves work. It can hint at a thickened wall, but it cannot measure one. Which rhythm the heart is in, apart from the beats occurring during the scan.
Radiation None. It records the heart’s own signals. None. It uses sound waves.
Preparation None needed. None needed.
Cost at our clinic (incl. GST) From S$49.05 S$436 at Jurong · S$545 at Orchard

The two tests are not alternatives to one another. An ECG cannot measure pumping strength, and an echocardiogram cannot tell you what rhythm you were in yesterday. Which test you need follows from what your symptoms suggest, and a great many patients are sensibly offered both.

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The Common Question

Which Is Better, an ECG or an Echocardiogram?

There is no general winner. Each test is accurate at a different job.

The ECG is more accurate for rhythm

It reads the heart’s electrical signal directly. That is the only way to name a rhythm problem, or a fault in the wiring that carries the signal.

  • Atrial fibrillation, flutter, and the fast and slow rhythms grouped under arrhythmia
  • Delays and blockages in the heart’s wiring, such as a bundle branch block
  • A heart attack, whether it is happening now or left a pattern behind years ago
  • Strain on the heart, and salt imbalances in the blood, which change the shape of the tracing

Its blind spot: anything structural. A heart can pump at half its normal strength, or carry a badly leaking valve, and still give a tracing the machine reads as normal.

The echocardiogram is more accurate for structure

It produces a moving picture of the chambers, valves and muscle, and measures how hard the heart is actually working.

  • Valve problems, including what is causing a murmur and how badly a valve leaks or has stiffened
  • Pumping strength: the share of blood the heart pushes out with each beat. Measured here, and nowhere on an ECG
  • Wall thickness and chamber size, which matter in long-standing high blood pressure
  • Fluid around the heart, clots inside the chambers, and problems present from birth

Its blind spot: rhythm. It sees only the beats that happen during the scan, so a problem that comes and goes is usually missed.

An ECG can hint that a heart wall is thickened, but it flags this too often in slim people, and only a scan settles it. Someone with palpitations and someone with swollen ankles both need the “more accurate” test, and it is a different test each time. That is why the choice follows your symptoms.

Doing Both

Do You Need Both Tests?

Very often, yes. The two are not rivals. Each one covers the other’s blind spot.

1

Both, at the same visit

The common case. Some problems show up on an ECG long before anything changes on a scan. Others work the other way round: a leaking valve can show on ultrasound for years while the ECG stays normal. Both tests appear together in our heart screening packages from the Plus tier upwards.

2

The ECG first, the scan after

Atrial fibrillation is diagnosed on an ECG, since that is the only test that can name the rhythm. An echocardiogram then follows, because chamber size, valve function and pumping strength all influence how it is treated. The scan is not a second opinion on the diagnosis; it answers the next question.

3

An ECG on its own

Enough when the question is narrow. A pre-employment check, an insurance medical or a routine screening usually calls for a resting ECG and nothing more.

4

An echocardiogram on its own

A murmur heard by your doctor usually calls for a 2D echocardiogram and nothing more. The question is what the valves are doing, and an ECG cannot answer it.

The Shared Blind Spot

What Neither Test Can Show You

Narrowed arteries are beyond both tests. If your arteries are narrowed but still delivering enough blood while you sit still, a resting ECG usually looks normal. An echocardiogram pictures the heart muscle, not the arteries feeding it. Three other tests answer that question.

Treadmill Stress Test

An ECG recorded while you walk on an incline, so the heart is asked for more blood than it needs at rest.

CT Calcium Score

A short scan that measures hardened calcium in the artery walls and turns it into a single risk score.

CT Coronary Angiogram

A scan using a dye, which shows the arteries themselves — where a narrowing sits, and how tight it is.

A rhythm problem that comes and goes can also escape both tests, simply because it may not occur during either recording. That gap is closed by a Holter monitor, which records continuously over 24 hours or longer.

Fees

What an ECG and an Echocardiogram Cost in Singapore

Our published fees for both tests. All prices are NETT and inclusive of 9% GST.

Published clinic fees for an ECG, a 2D echocardiogram and a cardiologist consultation
Service Price
Tests
Electrocardiogram (ECG) From S$49.05
2D Echocardiogram (Jurong) S$436
2D Echocardiogram (Orchard) S$545
Consultation
First Consultation with Cardiologist (Jurong) S$130.80
Follow-up Consultation with Cardiologist (Jurong) S$98.10
First Consultation with Cardiologist (Orchard) S$218
Follow-up Consultation with Cardiologist (Orchard) S$163.50

A consultation is required unless you have a referral letter from another doctor. See all published cardiology fees.

In Practice

Which Test You Will Be Offered, and When

A rough guide to how symptoms map onto the two tests. Your own assessment may differ, since history and examination findings shape the decision as much as the presenting symptom does.

  • Palpitations or a racing heart An ECG first. If the sensation comes and goes, a Holter monitor usually follows, because a 10-second tracing rarely catches an intermittent rhythm.
  • Breathlessness or swollen ankles An echocardiogram, since these point towards pumping function and the valves rather than towards the electrical system.
  • A murmur heard by your doctor The clearest single indication for an echocardiogram. A murmur is a sound made by blood crossing a valve, and only a scan shows what the valve is doing.
  • Chest pain on exertion An ECG at rest, then a treadmill stress test or CT scan. The resting tracing is often normal between episodes.
  • Fainting Warrants an ECG early, with an echocardiogram added where a structural cause is suspected.
  • A health screening or pre-employment check Typically includes a resting ECG, with an echocardiogram added in the higher screening tiers.

Not Sure Which Test You Need?

If you have been offered one of these tests and are concerned, or would simply like a second opinion, book a consultation with Dr Paul Lim. Bring any previous ECG tracings or scan reports with you.

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Dr Paul Lim, Senior Consultant Cardiologist, at his Singapore clinic
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Where to Get an ECG or Echocardiogram in Singapore

The Straits Heart @ Orchard

In the heart of Orchard

@ The Straits Eye Centre

1 Orchard Blvd, #06-07/08
Singapore 248649

The Straits Heart @ Jurong

Bringing heart-felt care to the community

@ ATA Medical Clinic (Jurong)

21 Jurong Gateway Rd, #02-07
Singapore 608546

Opening Hours

Monday – Friday8:30 AM – 5:30 PM
Saturday8:30 AM – 12:30 PM
Sunday & Public HolidaysClosed

By Appointment Only

Common Questions

ECG vs Echocardiogram: FAQ

The questions patients ask most when they are weighing one test against the other.

Which is better, an ECG or an echocardiogram?

Neither, in general. They answer different questions. An ECG is more accurate for heart rate and rhythm — it reads the heart’s electrical signal directly. An echocardiogram is more accurate for structure and pumping strength, because it produces a moving picture of the chambers, valves and muscle. The right one depends on your symptoms, which is why they are often ordered together.

Can an ECG detect a blocked artery?

Only indirectly, and often not at all. An ECG changes when heart muscle is short of blood during the recording, and it shows the pattern left by a previous heart attack. But an artery can be narrowed and still deliver enough blood at rest, and then the ECG looks completely normal. Narrowed arteries are tested for with a treadmill stress test, a CT calcium score or a CT coronary angiogram.

Do I need an ECG if my echocardiogram is normal?

Often yes. A normal echocardiogram tells you the heart’s structure and pumping strength look normal. It says very little about rhythm, because it sees only the beats that happen during the scan. If your symptoms are palpitations, a racing heart or fainting, the test that addresses them is an ECG, and sometimes a Holter monitor worn for 24 hours or longer.

Are an ECG and an EKG the same test?

Yes. ECG and EKG are two names for the same test, the electrocardiogram. ECG follows the English spelling and is standard in Singapore, the UK and most of the Commonwealth. EKG comes from the German Elektrokardiogramm and is common in the United States. There is no difference in the test, the equipment or the result.

Can an echocardiogram detect a heart rhythm problem?

Only if the abnormal rhythm happens to be running during the scan, and even then an ECG is needed to name it. An echocardiogram is an ultrasound of structure and movement, not a recording of the electrical signal. It does have a role in rhythm disorders, but a different one. Once atrial fibrillation is diagnosed on an ECG, an echocardiogram checks the valves, chamber size and pumping strength, because those affect how it is treated.

How much do an ECG and an echocardiogram cost in Singapore?

At our clinic an ECG is from S$49.05 and a 2D echocardiogram is S$436 at Jurong or S$545 at Orchard, both inclusive of GST. The gap reflects the equipment and the time: an ECG takes 5 to 10 minutes, an echocardiogram 20 to 45. A cardiologist consultation is also needed so the right test is ordered and the results explained, unless you already have a referral letter from another doctor. See all published fees.

Evidence & Sources

Where This Guidance Comes From

This page is educational and is not a diagnosis. Which test you need is decided alongside your symptoms, history and examination findings — which is what a cardiology consultation is for.

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