Medical Oncologist
CION Cancer Clinics
What an ECG and echo before surgery are looking for | CION Cancer Clinics
An ECG before surgery checks your heart's rhythm and electrical signals. An echo is an ultrasound that shows how well the heart pumps and whether the valves work. Surgery and anaesthesia put extra strain on the heart, so these tests help the team plan safely. Most people need an ECG. An echo is added when there is a reason to look more closely. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- Why are an ECG and an echo done before surgery?
- How are an ECG and an echo different?
- What can these tests find that matters for surgery?
- What happens if the ECG or echo is not normal?
- What do the words on an ECG or echo report mean?
- What do families often misunderstand about heart tests?
- Why does chemotherapy before surgery change the heart checks?
- Common questions about ECG and echo before surgery
The short answer
Why are an ECG and an echo done before surgery?
An ECG checks the heart's rhythm and electrical signals. An echo is an ultrasound that shows how well the heart pumps and whether its valves work. Together they tell the anaesthetist whether your heart can handle the strain of an operation.
Why the heart matters so much during surgery
Anaesthesia, blood loss, fluids and pain all make the heart work harder. A heart that copes well in daily life may struggle under that extra load. Knowing about a weak pump, a narrowed valve or an irregular rhythm in advance lets the team choose medicines, fluids and monitoring to suit you.
Not everyone needs both
An ECG is quick, cheap and very common before cancer surgery, especially for older adults. An echo is usually added when there is a reason: known heart disease, breathlessness, swollen feet, a heart murmur, an abnormal ECG, or chemotherapy drugs that can affect the heart.
What this page cannot tell you
It cannot read your own report or say whether you are fit for your operation. Heart findings are judged alongside your symptoms, your other tests and the size of the surgery planned. Only your team can put those together.
Side by side
How are an ECG and an echo different?
ECG
Echo
Records the heart's electrical signals
Shows moving pictures of the heart using ultrasound
Stickers on the chest, arms and legs
A gel-covered probe moved over the chest
Finds rhythm problems and signs of past strain
Finds a weak pump, valve problems and fluid around the heart
Done for most people before major surgery
Added when there is a specific reason to look
Takes a few minutes
Takes longer, and is usually read by a heart doctor
Not sure whether this applies to you?
Ask an oncologistWhat is being looked for
What can these tests find that matters for surgery?
Most reports are normal or show small changes that do not alter the plan. These are the findings that can.
An irregular rhythm
A fast or irregular beat, such as atrial fibrillation, may need control before surgery. Some people with it also take blood thinners, which need a plan around the operation.
Signs of a past heart attack
An ECG can show changes from an old heart attack, even one that went unnoticed. The team may then ask a heart doctor to assess the risk.
A weak pump
The echo shows how strongly the main pumping chamber squeezes. A weak pump changes how fluids and anaesthetic drugs are given.
A tight or leaking valve
Valve problems can make blood pressure hard to hold steady under anaesthesia. A severe one may need attention first.
Often first noticed as
- A murmur heard with a stethoscope
- Breathlessness on walking
If a finding needs a closer look
What happens if the ECG or echo is not normal?
-
The anaesthetist reviews it
Many small changes are common and harmless. The anaesthetist decides whether a finding matters for your operation or can simply be noted.
-
A heart doctor may be asked
If the finding needs expert judgement, a cardiologist sees you. They look at your symptoms, the reports and your medicines.
-
More tests, for some
A stress test, a heart rhythm recording over a day or a scan of the heart's blood vessels may be suggested. These are not routine.
-
Treatment or a change in plan
Medicines may be adjusted, extra monitoring planned, or a bed in intensive care kept ready after the operation.
-
The decision is shared with you
The surgeon, anaesthetist and heart doctor explain whether surgery can go ahead, what the added risk is and what the choices are.
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On your report
What do the words on an ECG or echo report mean?
- Sinus rhythm
- The heart's normal, regular rhythm. This is what most people want to see.
- Ejection fraction (EF)
- How much blood the main chamber pushes out with each beat, written as a percentage. A lower figure means a weaker pump.
- Regional wall motion abnormality
- Part of the heart wall is not moving as well as the rest, sometimes from an old heart attack.
- Diastolic dysfunction
- The heart is stiffer than usual when it relaxes and fills. Mild forms are very common with age and blood pressure.
- Regurgitation or stenosis
- A valve that leaks backwards, or one that is narrowed. Reports grade them as mild, moderate or severe.
- Non-specific ST-T changes
- Small ECG changes that often mean nothing serious, and are read alongside your symptoms.
Commonly believed
What do families often misunderstand about heart tests?
"A normal ECG means the heart is perfect."
An ECG shows the rhythm at that moment. It cannot show every narrowed blood vessel or valve problem. That is why symptoms like chest pain or breathlessness on walking still matter, and must be mentioned.
"An abnormal report means surgery is off."
Most abnormal findings lead to a plan, not a refusal. The team may adjust medicines, add monitoring or ask a heart doctor. Many people with heart disease have cancer operations safely.
"An echo uses radiation, so it is harmful."
An echo uses sound waves, the same kind used to look at a baby in pregnancy. It does not use radiation and can be repeated when needed.
"He had an echo last year, so another is a waste."
Hearts change, especially after chemotherapy or a new illness. A recent echo may still be useful, so bring it. The team decides whether it can be used or needs repeating.
Before and after chemotherapy
Why does chemotherapy before surgery change the heart checks?
Some cancer drugs can weaken the heart, so an echo is often checked before surgery if you have had them. The report is compared with any echo done before treatment started.
Drugs the team will ask about
Doxorubicin and epirubicin, trastuzumab (sold under brand names such as Herceptin), and some other targeted drugs are well known for this. Bring your chemotherapy chart or discharge summary, because the exact drug names matter more than the word "chemo".
Who needs extra care
People with a weak heart, severe valve disease, a recent heart attack or chest pain that comes on easily need the most careful planning. For a few, the risks of a large operation may be too high, and the team will discuss other ways forward.
What you should tell the team
Tell them about chest pain, breathlessness when lying flat, fainting, palpitations or swollen feet, even if the tests were normal. Do not stop any heart medicine before surgery unless your doctors tell you to. If you have seen a heart doctor before, bring their latest letter and your old ECGs, so any change can be spotted quickly.
Questions we are asked
Common questions about ECG and echo before surgery
Do I need to fast before an ECG or echo?
Usually not. Both tests can be done after a normal meal. Wear clothes that let you uncover your chest easily, and avoid applying body lotion or oil on the day, because it can stop the stickers holding. Take your regular medicines unless you have been told otherwise.
Does an echo hurt?
No. You lie on your side while a probe with cool gel is moved over your chest. There may be some pressure, and the gel feels cold. No needles are used for a standard echo. Women can ask for a female technician or chaperone if they prefer.
My ECG says "abnormal". Should I be worried?
Not necessarily. ECG machines print automatic comments that often flag small, harmless changes. A doctor needs to read the tracing alongside your age, symptoms and older ECGs. Bring the report to your check-up and ask what it means for your operation.
What is a normal ejection fraction?
Reports usually say whether the pumping function is normal, mildly reduced or more reduced. The number on its own does not decide surgery. The team looks at it with your symptoms and valve findings. Ask the doctor to explain what your figure means for you.
Will I need a stress test or angiogram?
Most people do not. These are suggested when there is chest pain, a suspicious ECG or a weak area on the echo, and when the result would change the plan. A heart doctor usually makes this call with the surgical team.
I have a pacemaker. Does that change anything?
Yes, tell the team early and bring your pacemaker card. The device may need checking or setting before surgery, because some surgical equipment can interfere with it. The anaesthetist arranges this with the heart team.
Can the ECG be done at a local clinic?
Often yes, if it is recent. Bring the actual tracing, not only the written comment. An echo report from a recognised centre can also be reviewed. The anaesthetist decides whether a repeat is needed at the hospital doing the operation.
Are these heart tests covered by Aarogyasri or insurance?
They are often covered when they are part of an approved cancer surgery plan. Aarogyasri, CGHS, ECHS, EHS and cashless insurance each have their own rules. Call the helpline with your card or policy details and the team can check your cover.
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Dr. C. Raghavendra Reddy
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Sources
- NHS — Electrocardiogram (ECG)
- NHS — Echocardiogram
- NICE — Routine preoperative tests for elective surgery (NG45)
- Royal College of Anaesthetists — Patient information
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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