An electrocardiogram (ECG) is a test that measures the electrical activity of the heart. It is a quick, safe, and painless procedure used to detect and record the electrical activity of the heart. Whenever the muscles of the heart contract, they produce small electrical signals. Healthcare professionals can monitor these signals using precise electronic instruments to understand the health of the heart.
In addition to evaluating the rhythm and rate of the heart, an ECG can also detect various heart conditions and symptoms such as heart disease and heart enlargement.
What do the different waveforms represent?
What do waveforms represent?
An ECG consists of a series of waveforms, namely the P wave, QRS complex, and T wave, which represent the following:
| P wace | Represents the electrical activity generated during the depolarization of the atria, also known as atrial depolarization wave. |
| QPS complex | Reflects the rapid depolarization process of the left and right ventricles. |
| T wave | Also known as the repolarization wave, it represents the electrical activity of the ventricles recovering or returning to a resting state. |
1. Resting Electrocardiogram (ECG)
Purpose
- To determine if the cardiac electrical activity is normal.
- Doctors can assess the conduction speed and regularity of the electrical activity in the heart by measuring the time intervals on the ECG. This helps in identifying any abnormalities such as slow, fast, or irregular heart rhythms.
- To evaluate if the heart muscle is enlarged or stressed.
- By measuring the amount of electrical activity transmitted by the heart muscle, cardiac specialists can assess if certain parts of the heart are enlarged or under excessive strain.
Procedure
- The ECG examination is quick and painless, and patients do not experience any discomfort or risks.
- There may be a slight discomfort when removing the ECG electrodes.
Precautions before the examination
- Avoid using oily skincare products to ensure proper electrode-skin contact.
- Avoid wearing long stockings, as the electrodes need to be directly attached to the legs.
- Wear a shirt that is easy to remove to facilitate the placement of leads by healthcare personnel.
- Inform healthcare personnel in case of any allergies to adhesive tapes or adhesives used for attaching electrodes.
Time required
- Approximately 10 minutes for preparation and completion of the test.
- The actual recording process takes only a few seconds.
2. Holter Continuous Electrocardiogram
Purpose
- To allow doctors to observe the heart activity of patients with arrhythmias (abnormal heart rhythms).
- Wearing a Holter monitor provides doctors with insights into the causes of symptoms such as dizziness, lightheadedness, rapid heartbeat, or irregular heart rhythms and determines if the heart is receiving sufficient oxygen to meet its demands.
- To assess the proper functioning of a pacemaker.
- If a patient has a pacemaker and experiences dizziness, a Holter monitor may be used to check if the pacemaker is functioning correctly.
- To evaluate the effectiveness of medication.
- Doctors may observe the ECG to assess the effectiveness of medication during the patient’s treatment.
Procedure
- Wearing a Holter monitor does not involve any risks or cause pain.
- The wires of the Holter monitor connect to small discs (electrodes) attached to the chest to record the ECG.
Precautions before the examination
- Inform healthcare personnel of any allergies to adhesive tapes or adhesives used for attaching electrodes.
Time required
- 24 to 48 hours or longer, depending on the type of monitoring device used.
3. Exercise Stress Test (Exercise ECG)
Purpose
- To diagnose coronary artery disease.
- To diagnose symptoms possibly related to the heart, such as chest pain, shortness of breath, or dizziness.
- To determine safe levels of exercise.
- To examine the effectiveness of bypass surgery in improving patients with coronary artery disease.
- To predict risk associated with heart disease, such as the risk of a heart attack.
- Based on the results of the exercise stress test, the doctor may recommend further tests such as myocardial perfusion scanning or cardiac catheterization.
Procedure
- You will be connected to monitoring devices to monitor your heart.
- You will walk slowly on a treadmill. The speed and incline of the treadmill will gradually increase to simulate an uphill effect.
- You can stop the test at any time if needed.
- You may be asked to sit or lie down to examine your heart and blood pressure.
- After the test, you will walk slowly or rest for a few minutes to cool down. Your heart rate, blood pressure, and ECG will continue to be monitored until they return to normal levels.
Precautions before the examination
- Avoid consuming caffeine or ingesting anything within 12 hours before the test.
- Avoid eating or drinking anything except water within 4 hours before the test.
- Do not take cardiac medications on the day of the test unless instructed otherwise by your doctor or if they are needed to relieve chest discomfort.
- If you use an inhaler for breathing, bring it with you to the test.
- Inform healthcare personnel if you experience chest or arm discomfort, shortness of breath, dizziness, or any other abnormal symptoms.
Time required
- The entire examination takes about 1 hour.
- The exercise duration lasts approximately 7 to 12 minutes.
1. Rhythm Abnormality
Definition
Arrhythmia refers to irregular, fast, slow, or abnormal heart rhythms. Patients may sometimes not feel any symptoms, but in other cases, they may experience noticeable palpitations or a sensation of “heart fluttering.” If you experience any abnormal heartbeats, it is important to seek medical help immediately so that the doctor can identify the cause and provide appropriate treatment.
Symptoms Reflected in the ECG
- Sinus Bradycardia (slow rhythm/fast rhythm)
- Sinus Tachycardia (fast rhythm)
- Atrial Fibrillation (coarse/fine)
- Atrial Flutter
- Ventricular Rhythm
- Ventricular Tachycardia
- Ventricular Fibrillation
- Sinus Arrhythmia
- Missed beat at 80/120 BPM
- Paroxysmal Atrial Tachycardia (PAT)
- Nodal Rhythm
2. Electrical Conduction Abnormality
Definition
Conduction abnormalities refer to problems in the heart’s electrical conduction system, which controls the rate and rhythm of the heartbeat. Normally, the heart releases electrical signals to stimulate the contraction of the heart muscle, pumping blood to the lungs and throughout the body. If there are abnormalities in the conduction system, it can result in the inability to generate electrical signals properly or stimulate the heart muscle, posing a threat to the body and even life-threatening. Therefore, if you suspect any irregularities in your heart rhythm, immediate medical attention should be sought.
Symptoms Reflected in the ECG
- First Degree A-V Heart Block
- Second Degree A-V Heart Block
- Third Degree A-V Block
- Right Bundle Branch Block (RBBB)
- Left Bundle Branch Block (LBBB)
- Premature Atrial Contraction (PAC)
- Premature Nodal Contraction (PNC)
- Premature Ventricular Contraction (PVC)
- Bigeminy
- Trigeminy
- Couplet (Two PVCs together)
3. Structural/ Functional Abnormality
Definition
Structural or functional abnormalities of the heart refer to defects or abnormalities in the heart’s internal valves or blood vessels, causing an improper flow of blood. These abnormalities can involve various locations within the heart, such as the heart walls, valves, arteries, or veins. Structural heart diseases can be congenital or acquired, and some structural abnormalities may not be detectable in childhood and may only become apparent in adulthood. Statistics show that about 1 in every 150 adults has some form of congenital heart disease.
Symptoms Reflected in the ECG
- Right Bundle Branch Block (RBBB)
- Left Bundle Branch Block (LBBB)
- Ischemia
- Ventricular Hypertrophy
Electrocardiogram (ECG) monitors are widely available on the market, but not all models are clinically certified. Generally, ECG monitors used in clinics and hospitals are certified for safety and accuracy. However, some products in the market may exaggerate their capabilities. It is advisable for individuals to seek professional advice from healthcare personnel and choose a product that meets their actual needs.
According to the US Food and Drug Administration (FDA), the use of the electrocardiogram (ECG) app on the Apple Watch is not recommended for users with known arrhythmias. The displayed data on the ECG app is for reference only and is not intended for clinical use.
- Avoid vigorous exercise for 1 hour before the examination.
- Avoid smoking.
- Avoid consuming stimulating and caffeinated beverages like coffee or tea.
- Avoid wearing items that may interfere with electrical conduction, such as metal jewellery, watches, socks, etc.
What to avoid after ECG test?
There are typically no restrictions, and normal activities can be resumed after the examination.
Holter Monitor Electrocardiogram
| Hospital／Clinic | Pricing |
| Private patient services at public hospitals | HK$2,830－HK$9,910 |
| Gleneagles Hospital Hong Kong | HK$3,000 |
| Hong Kong Baptist Hospital | HK$2,940-HK$4,410 |
| CUHK Hospital | HK$2,430 |
| Hong Kong Sanatorium & Hospital | HK$3,360－HK$6,720 |
| St. Paul’s Hospital | HK$2,600－HK$4,420 |
| HK Cardia Centre | HK$2,400 |
| Central Health Center | HK$2,100 |
| Swindo Medical | HK$2,560－HK$5,400 |
Exercise ECG Test
| Hospital／Clinic | Pricing |
| Private patient services at public hospitals | HK$2,830 |
| Gleneagles Hospital Hong Kong | HK$3,420 |
| Hong Kong Baptist Hospital | HK$2,940-HK$4,410 |
| CUHK Hospital | HK$2,340 |
| Hong Kong Sanatorium & Hospital | HK$4,320 |
| St. Paul’s Hospital | HK$2,600 |
| HK Cardia Centre | HK$2,600 |
| Central Health Center | HK$2,300 |
| 仁和體檢 | HK$2,710 |
Bowtie Voluntary Health Insurance Scheme provides coverage for “Diagnostic Examinations” which are medical tests recommended by your attending registered doctor based on your symptoms ECG test is a coverage item under the “miscellaneous expenses” category in the VHIS. It is important to note that the coverage amounts may vary among different schemes. The table below provides the annual coverage amounts for the Bowtie’s VHIS Flexi and Bowtie Pink for your reference:
Interested in purchasing medical insurance, but are unsure of the cost?
Bowtie offers a premium calculator to estimate the monthly premium for VHIS based on factors such as age, gender, and smoking habits:
Bowtie VHIS (Standard/ Flexi) Premiums Calculator
Bowtie Pink Premiums Calculator
How to get full coverage other than buying Bowtie Pink?
By purchasing the Bowtie Gleneagles Hong Kong Hospital Medical Health Package for HK$200 per month regardless of age, in addition to enrolling in the Bowtie VHIS Flexi Plan, you can receive full compensation* for designated surgeries or medical examinations conducted at Gleneagles Hong Kong Hospital.
For example, Gleneagles Hong Kong Hospital provides a chest pain screening package that includes an echocardiogram and a stress test, with prices ranging from HK$13,960 to HK$18,160 (depending on the risk level). Bowtie Voluntary Health Insurance (Flexible Plan) policyholders who have successfully purchased the package will be eligible for full compensation*.
In addition, the Gleneagles Hong Kong Hospital Medical Health Package provides full compensation for over 240 medical packages covering various specialties such as cardiology, ENT, gynecology, and more.
Situation 1: Have company medical insurance + far from retirement
In this situation, you may consider enrolling in the Bowtie Pink, which includes a deductible. Even if you unfortunately become ill and require medical examinations or treatments, you can use your company medical insurance to offset the deductible, and the remaining fees can be fully compensated through Bowtie Pink. The premium for this plan may also be cheaper than plans without a deductible.
Situation 2：Close to retirement + lose group medical coverage
In this situation, it is recommended that you enroll in the Bowtie VHIS (Flexi) and add on the Bowtie Gleneagles Hong Kong Hospital Medical Health Package for HK$200 per month. This not only provides full compensation coverage but also has lower premiums compared to Bowtie Pink, making it a suitable option for individuals who wish to reserve money for retirement funds.
Claims Process
Bowtie’s voluntary health insurance claims process is simple and straightforward. Here are the steps:
- Prepare the required documents
- Log in to your Bowtie account and apply for the claim (click on the “Log in to Claim” button on the left)
- Answer a few questions about the medical examination
- Submit your bank details
- Upload the required documents
- Wait for approval
- Receive your compensation
What documents are needed for the claim?
You will need to prepare the following three documents to successfully apply for the claim:
- Hospital compensation application form filled and signed by the doctor
- Original hospital receipt
- All pathology reports
Private hospitals usually have hospital compensation application forms for different insurance companies. As long as you let the doctor know which medical insurance you have bought, they will have experience in filling out the form. It is recommended to prepare a list of your medical insurance c overage for the doctor’s reference.
How long does it take to receive compensation after applying for the claim?
The time required for each claim depends on the complexity of the case. About 80% of cases are approved within 10 working days, and the compensation amount will be transferred to your designated bank account within 3 working days after successful approval.
What is the normal range of ECG test?
Generally, the normal range for an ECG is a heart rate of approximately 60 to 100 beats per minute.
How often should you undergo ECG test?
If you don’t have any known heart problems, an annual ECG is sufficient to monitor your health. However, if you have known heart conditions, regular ECG tests are recommended. The actual frequency and type of ECG will vary depending on individual circumstances. Please consult with your doctor for specific recommendations and arrangements.
Author
The Bowtie Life Insurance Company Limited is an authorized life insurance company and Hong Kong’s very first virtual insurer approved. Through the use of modern technology and medical expertise, Bowtie offers an agent-free, commission-free and more convenient online platform for customers to quote, apply and claim for Voluntary Health Insurance Scheme (VHIS) anytime anywhere. Bowtie is ranked first in the direct channel sales throughout 2021.
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www.bowtie.com.hk The above content is provided by the Bowtie Team team. The information is for reference only and cannot replace any personal advice given by qualified medical professionals.
