Screening check
Do I need a screening ECG?
An electrocardiogram (ECG or EKG) records the heart's electrical activity. The US Preventive Services Task Force looked at whether adults with no symptoms should have one to prevent heart attacks and strokes. The answer depends on your 10-year risk.
About you
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What you will see
What the USPSTF says about a screening ECG for you.
Educational only, not medical advice. This is not a heart test. Talk to a clinician about any symptoms.
Source
US Preventive Services Task Force, June 2018 recommendation on screening for cardiovascular disease risk with electrocardiography. It is the current statement.
Validated in
Adults without symptoms of, or a diagnosis of, cardiovascular disease.
Limits
It does not estimate your risk; you need a risk number from a clinician or a calculator. It does not cover people with symptoms or known heart disease.
What the USPSTF recommends
| Who | Recommendation | Grade |
|---|---|---|
| Adults without symptoms at low risk of cardiovascular events | Do not screen with resting or exercise ECG | D |
| Adults without symptoms at intermediate or high risk | Evidence is insufficient to weigh the benefits and harms of screening with resting or exercise ECG | I |
The statement describes 10-year risk under 10% as low, 10% to 20% as intermediate and over 20% as high on the Framingham score; on the Pooled Cohort Equations, under 7.5% is low and 7.5% or more is elevated. The USPSTF recommends that clinicians use the Pooled Cohort Equations (USPSTF 2018). It applies to adults without symptoms or a diagnosis of cardiovascular disease (USPSTF 2018).
What the tests are
A resting ECG records the heart's electrical activity for a short time while you are at rest. An exercise ECG records it during exertion, most often on a treadmill. Both look for signs of a past heart attack, reduced blood flow to the heart and other changes such as a thickened heart wall or an irregular rhythm (USPSTF 2018).
Why screening can do harm
In every risk group, an abnormal ECG, whether a true or a false positive, can lead to invasive follow-up tests and treatment with a potential for serious harm, including unnecessary radiation (USPSTF 2018). In two studies of adults with diabetes and no symptoms, 6% and 12% of those screened with an exercise ECG went on to angiography and 3% to 5% had a procedure to open arteries, without evidence of benefit (USPSTF 2018). Those procedures carry risks such as bleeding, kidney injury from contrast dye, stroke, heart attack and death (USPSTF 2018).
Common questions
What raises the risk of heart attack and stroke?
Older age, male sex, high blood pressure, current smoking, abnormal cholesterol, diabetes, obesity and physical inactivity (USPSTF 2018).
What lowers the risk if mine is raised?
Usually a mix of diet and exercise changes, cholesterol-lowering medicine, aspirin for some people, blood pressure treatment and help to stop smoking (USPSTF 2018). People already at high risk should get intensive risk factor treatment whatever an ECG shows (USPSTF 2018).
What about pilots and similar jobs?
For people whose sudden illness could endanger others, such as pilots and heavy equipment operators, reasons other than their own health may affect the decision to screen (USPSTF 2018).
Also see the heart risk calculator, the statin check, the atrial fibrillation screening check and all screening tests by age.
Sources
- US Preventive Services Task Force. Screening for Cardiovascular Disease Risk With Electrocardiography: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(22):2308-2314. www.uspreventiveservicestaskforce.org/uspstf/recommendation/cardiovascular-disease-risk-screening-with-electrocardiography
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-10-30. Spotted an error? See About.