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Electrocardiogram (ECG/EKG): Procedure, Uses and Results

Posted on by Prof. Dr. İbrahim Cansaran TANIDIR

ECG is a fast and painless electrocardiography method that captures the natural electrical signals produced by the heart with each beat from the body surface and transfers them onto paper. This test, which documents the rhythm, rate, and working pattern of the heart within seconds, is professionally performed with the help of sensitive electrodes placed on the chest, wrists, and legs. This technical process, used in the discipline of pediatric cardiology to evaluate heart health in depth, is a completely needle-free and safe procedure. This procedure, which maps the electrical activity of your heart, allows us to clearly see the communication between the chambers of the heart and its contraction power, and is considered one of the most important indicators of healthy development in children.

What is ECG?

The heart is undoubtedly the most miraculous and hardworking organ of the human body. This magnificent pump, which works tirelessly in its own inner world, needs a perfectly functioning electrical network in order to send the blood inside it to the vessels. ECG is a very basic health test that listens to these unique electrical signals produced by the heart from the outer surface of the body and converts them into visible wavy lines on paper. We can compare the heart to the wiring system of a house. In the upper right chamber of the heart, there is a natural generator present from birth. This generator produces electrical sparks at regular intervals. These sparks rapidly spread to the lower chambers through special cable lines laid along the heart walls. As soon as the electrical signal reaches the cells, contraction occurs and blood is ejected. This device used captures these silent commands reflected by the heart onto the skin. The data provide physicians with a detailed map of the heart’s tempo and rhythm. This procedure not only takes an instant snapshot of the heart but also shows how flawlessly the wiring system works. In this way, all possible risks can be detected long before they even begin.

Why are ECG results in children different from the adult heart?

A child’s heart is not simply a smaller copy of an adult human heart. From the first days of infancy until adolescence, this vital organ is on a continuously evolving developmental journey. While in the womb, babies’ blood circulation load is largely carried by the right side of the heart. Because of this physiological reality, babies are born with the right side of their hearts more muscular and more dominant. As the years pass, the left side takes over the task of pumping blood to the growing body, and the center of gravity shifts to the left. Each of these growth stages is reflected on paper as completely different wave sizes and directions. Moreover, since children’s metabolisms work very fast, their heart rates are quite high compared to adults. A rapid rhythm that may be considered palpitation in an adult may be a completely healthy and expected picture for an active child. For this reason, when test results are evaluated, each child’s own age, height, and weight are taken into account with great care. One of the greatest subtleties of pediatric cardiology is hidden precisely in these details.

When which complaints are seen is ECG recording necessary for your child?

In order to protect children’s heart health and detect possible problems early before they grow, it is necessary to take certain signals given by the body seriously. Especially in very active children, the most reliable way to understand whether the heart is experiencing electrical strain is through this unique test. Sometimes hearing a different murmur in the heart with a stethoscope during a routine doctor’s examination may make this test necessary. Sometimes, the discomforts your child describes to the parents while playing become a triggering factor. Situations in which the electrical structure of the heart should be measured are as follows:

  • Chest pain
  • Feeling of palpitation
  • Unexplained fainting
  • Momentary blackouts
  • Bluish discoloration of the lips
  • Bluish discoloration of the nail beds
  • Excessive sweating while breastfeeding
  • Easy fatigue
  • Shortness of breath
  • Getting exhausted during exercise
  • Chest pain during exercise
  • Dizziness

Such complaints may not always be a sign of a very serious disease, but ECG is an absolute necessity to correctly read these symptoms, which are the language of the heart, and such complaints should always be carefully considered.

How should you psychologically prepare your child for ECG recording?

The hospital environment, unfamiliar people, and large devices are naturally a major source of anxiety for children. Relaxing the child psychologically is actually the most important secret to obtaining an accurate and clean result. Because the heartbeats of a frightened and crying child suddenly accelerate, breathing becomes irregular, and tremors that make reading the graph difficult occur because the body contracts. Before entering the procedure room, you can explain to the child that this is a completely painless and very fun game and that only colorful stickers that will take a picture of the heart will be attached. In younger age groups, the reassuring voice and affectionate touch of the parent create miracles. When entering the recording room together, holding the child’s hands and distracting them by talking about their favorite toy will be helpful. In babies, having their stomachs full just before the procedure and catching that calm moment when they are inclined to fall asleep is a detail that makes the process incredibly easier. This approach will easily break all their prejudices against the hospital.

What are the physical preparation steps before ECG recording?

After psychological preparation is provided, it is also extremely important to make the child physically suitable for this test. A clean surface is needed to collect those very weak signals emitted by the heart from deep within the body through the skin without any interference. In order for the procedure to proceed quickly and smoothly without any problems, the preparation steps applied by parents and healthcare personnel are as follows:

  • Removing upper clothing
  • Drying sweat on the skin
  • Cleaning the skin surface
  • Wiping off creams on the body
  • Using a pacifier
  • Laying the child on a comfortable bed
  • Leaving the arms free
  • Extending the legs straight
  • Removing metal jewelry
  • Relaxing the body
  • Remaining as calm as possible

These physical preparation steps ensure that the measuring sensors adhere completely and fully to the skin like a vacuum. Thus, a solid foundation is prepared for the commands reflected from the heart onto the skin to be heard by the device very clearly, purely, and without error. Small details to be considered before the procedure are actually the guarantee of the entire result.

Does the ECG procedure hurt or cause pain?

One of the issues that concerns families and especially those little children the most is whether this test will hurt. In this regard, parents should be completely reassured and should easily reflect this confidence to the child. The procedure is absolutely an extremely harmless application that does not cause any pain, ache, burning, or discomfort. The device standing in the corner of the room does not give any external electrical current, radiation, or heat to the body. Its entire logic is based on passive listening and recording. Just like a microphone listens to sound in the air, this device only listens to the harmless electrical energy produced by the body itself and draws it on paper. During the procedure, no needle is inserted, no blood is drawn, and no hard pressure that would hurt the child’s skin is applied. The stickers attached to the chest and arms create only a very slight pulling sensation like adhesive bandages we use in daily life when they are removed after the recording is completely finished. It can be stated with peace of mind that this process is a completely relaxing experience.

What are the main differences of ECG devices used in children?

Developing medical technologies are specially designed to adapt perfectly to children’s delicate structures. If thick cables and large adhesive electrodes produced for an adult patient are tried to be attached to the narrow chest wall of a small child, these stickers will overlap, the signals will become mixed, and the results will be incorrect. Therefore, sensors used in pediatric patients are produced in much smaller sizes to fit perfectly on their tiny chest walls. Special silver materials that transmit the weak electricity in the body without loss are used in the parts that contact the skin. Considering babies’ skin, which is prone to redness, these stickers are made of non-allergenic, latex-free, anti-allergic sponges. The software aspect is also completely different. In order to correctly read children’s hearts beating at high speed, a very large algorithmic database is loaded into these smart devices. Thus, each measurement is analyzed by the machine according to the requirements of the child’s current age and guides specialists.

Where are ECG cables and adhesive stickers placed?

In order to create a multidimensional and flawless map of the heart, these small stickers are placed on strategic points determined according to the anatomy of the body. Throughout the recording process, connections are generally made to the arms, legs, and chest wall with great precision. Different colored clips attached to the arms and legs act like main security cameras looking at the heart from a distance. A complete electrical frame is created with connections to the right arm, left arm, left leg, and right leg, which balances the electrical current by grounding it. When moving to the chest area, six small stickers are lined up in sequence. These are windows that directly look closely at the chambers of the heart. Placement is made in a crescent shape starting from the right and left sides of the breastbone toward the left armpit. In newborn babies and children younger than five years old, since the right ventricle of the heart is structurally more dominant, additional special stickers are also attached to the right side of the chest, leaving no medically dark point.

What are normal ECG heart rates according to children’s ages?

The heart rate measured at complete rest tends to slow down regularly and naturally as the child grows older. As the autonomic nervous system matures during the growth process, the natural braking mechanism of the heart begins to work in a balanced way. The heart rates expected in a child with no health problem at rest are as follows:

  • Newborns 100-190/min
  • Babies under one year 100-180/min
  • Preschool children 80-140/min
  • School-age children 75-120/min
  • Adolescence/Adolescent 60-100/min

When the child breathes in, the heart slightly accelerates, and when the child breathes out, the rhythm slows down. This rhythmic fluctuation is a natural respiratory reflection and one of the best signs that the heart is healthy. However, if the beats go outside these age limits even when the child is making no effort, a very detailed examination by a specialist physician is essential.

What do the waves and shapes on ECG paper tell us?

Although the graphs on that long paper coming out of the machine may look like ordinary scribbles to parents, they are actually the instant translation of the heart. Each individual heartbeat creates wave groups on the graph that are named with letters according to international standards. The bump called the P wave represents the moment when the electrical signal starts from the upper chambers of the heart. If this wave is higher than normal, it is understood that there is strain in the upper part of the heart. The sharp high peaks that follow are called the QRS complex. These sharp peaks show the magnificent contraction when electricity reaches the lower chambers, which are the powerful pump of the heart, and blood is ejected to the body. The broad T wave at the end of the line depicts the moment when the tired heart muscle finishes that beat, enters rest, and recharges for the next beat. The flat distances between them express the short pauses in the conduction pathways and the electrical health of the heart completely, making diagnosis easier.

Which diseases can be detected early with ECG in children?

Thanks to this simple but intelligent test, which takes only a few seconds, many structural disorders that may be seen in childhood can be revealed at an early stage. The condition of the heart muscle due to a previous infection or hidden strain is largely reflected in the graph produced by the machine. The main heart problems that can be diagnosed without delay with this method are as follows:

  • Thickening of the heart wall
  • Right ventricular enlargement
  • Left ventricular enlargement
  • Congenital rhythm disorders
  • Heart conduction blocks
  • Extra heartbeats
  • Inflammation of the pericardium
  • Inflammation of the heart muscle
  • Electrolyte imbalances
  • Genetic channel diseases

Especially dangerous conditions in which the heart suddenly beats much faster than necessary or communication between the chambers is disrupted are detected through rhythm intervals even if they do not cause any physical symptoms. In cases of abnormal enlargement of the heart muscle, the path the electrical current must travel becomes longer, so the height of the waves visibly increases, rapidly warning the physician and providing a chance for intervention.

What factors cause incorrect drawings on ECG paper?

Even if everything in the clinic is done according to the rules, unwanted fluctuations or completely meaningless interruptions may occur in the graph during recording. This never means that there is a frightening problem in the child’s heart; it is entirely caused by technical problems related to environmental or bodily movements. In order to make an accurate medical interpretation, distinguishing artifacts is essential. Situations that cause difficult-to-read graphs are as follows:

  • The child feeling cold
  • Muscle trembling due to fear
  • Severe crying episodes
  • Excessive sweating of the skin
  • Deep breathing
  • Sudden tension of the cables
  • Stickers not adhering to the skin
  • Electrical interference from the outlet
  • The child moving
  • Contact with a metal bed

When a child cries, the chest muscles contract very strongly, and this muscle tension appears on paper as black lines resembling thick saw teeth, hiding the actual rhythm. For this reason, it is extremely important to keep the baby or child as calm as possible during the recording.

Why is Holter testing used when a normal ECG is not sufficient?

When a standard recording is performed in the hospital, it gives physicians an instant snapshot of the heart’s condition during those very brief few seconds. However, some complex heart conditions and sudden palpitations may have a very insidious character. Perhaps this problem only appears when the child is running in the schoolyard, dreaming at night, or suddenly becomes excited. Even if everything looks perfectly calm in the short recording taken at that moment in the clinic, long-term monitoring of the heart is necessary. At this point, 24-hour rhythm Holter evaluation comes into play. This device is a light and portable smart recording device attached to the child’s waist with a belt. Stickers are attached to the chest and the child returns to normal life. For exactly twenty-four hours, every time the heart beats, the device instantly records it into its memory. During this time, the family also writes down what the child does in a notebook. When the device is removed, the data are examined on the computer, hidden rhythm disorders are successfully detected, and treatment planning is made.

How are exercise ECG and tilt table tests performed in children?

Some cardiological diseases manage to remain completely hidden while the heart is at rest and only come to light when the body becomes tired. The exercise test is performed on a specially designed treadmill. Electrodes are attached to the child’s chest, and the speed and incline of that treadmill are increased under computer control. As the child runs and exerts effort, whether there is a decline in the contraction performance of the heart or a disturbance in rhythm is monitored instantly. The tilt table test is a special method used in children who faint for unexplained reasons. The reflex response of the child’s nervous system and vessels against gravity is intended to be observed. The child is laid on a safe table with belts, and the table is brought to an upright angle to imitate the standing position for a long time.

Güncellenme Tarihi: 13.10.2026

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