While I will "echo" (pun intended) the other responses that this forum may not be the best place to discuss general medical questions, it doesn't mean that such questions cannot be answered.
Your question is a broad one and reflects the need for a little education on what an ekg and an echo actually are:
Regarding EKG's, Back in the late 1800's some guys attached electrodes on humans and connected the electrodes to a needle and some graphing paper and then observed what happened. Over time as our knowledge of cardiovascular physiology increased we we have been able to relate certain ekg patterns with certain pathophysiologic syndromes. Thus, we do not directly visualize any cardiac pathology. However, because the heart produces abnormal ekg patterns that not only correlates well to pathophysiology but also in a very predictable way, it is a very powerful tool in the diagnosis of cardiovascular disease.
Echocardiography, on the other hand, uses ultrasound waves to directly visualize the heart. A probe sends out pulses of ultrasound waves. The ultrasound waves then do a number of thing: either penetrate tissue, reflect back to the probe, scatter, bend, etc. The waves that then reflect back to the probe are then plotted on a video screen based on the characteristics of the recorded US wave.
Echocardiography allows us to directly visualize cardiac pathology that may only be implied by ekg. Also using the physical characteristics of ultrasound waves and it's interaction with tissue and blood, we are able to learn a tremendous amount of physiology (hemodynamic information) in addition to anatomy.
1. What can an Echo detect that an ECG can't detect?
Ekg's do not provide direct information. The ekg pattern associated with left ventricular hypertrophy (enlargement of the heart) had to be learned with animal studies, autopsy studies, confirmation with other imaging studies, etc.. However, echocardiography can directly visualize enlargement of the heart chambers. One only needs to have the experience of seeing normal chambers before one easily can see left ventricular hypertrophy.
On the other hand, electrical disturbances of the heart, usually do not produce anatomically detectable changes and so ekg may be more beneficial for the diagnosis of such changes. Rhythm disturbances are especially difficult to diagnose solely by echocardiography. If a patient has a left bundle branch block (damage to the electrical conduction system in the heart), we cannot directly see the damage to the bundle branch with echocardiography (or even with autopsy).
What we can see with echo, however, is indirect evidence of conduction abnormalities. A LBBB causes asymmetric septal activation causing abnormal septal motion (which is visible on echo). HOWEVER, abnormal septal motion is not direct evidence of a LBBB and can be seen in various disorders. On ekg, detection of a LBBB is usually quite easy once one knows the typical pattern.
Bottom line, echo and ekg are complementary diagnostic procedures, and never competing.
There are a million examples, which I would love to go into but this post is already going to be too long.
2. Is a normal ECG reading a good indicator of a healthy heart, or do cardiologists usually do both ECGs and Echos?
A normal ekg is reassuring but not necessarily an indicator of health. I would argue that one's functional capacity (ability to exercise) is the best indicator of a healthy heart, and such information may not be seen on an ecg or an echo (although they may be hinted at).
Your question of do cardiologists "do" ecgs and echos needs clarification. Cardiologists will read ekgs and echos, and this is a routine part of their practice. There are subspecialists, but I won't go into that right now. Now, applying ekg pads and attaching them to a patient requires some training but not much. Thus, nurses, ekg techs, med students, residents, EMTs, fellows, and even cardiologists can "do" ekgs. Generally, a physician will ask a nurse to record an ekg on a patient, which the physician will then read.
Regarding echo, cardiologists read echos as part of their routine practice. They are also trained to perform echos as well. Now, perfoming an actual echocardiogram takes a great deal of skill and education, much more than recording an ekg. Ultrasonographers (ultrasound techs) go to school and generally require up to a year of practice before they are considered competent to independently scan. There is no question that ultrasonograpers are better at scanning than cardiologists, and cardiologists value a good ultrasonographer greatly. In addition, ultrasonographers generally are the ones to make the 1st diagnosis of cardiac pathology, which the cardiologists then just "confirms."
3. If a person were to have several heart palpitations per day, would a cardiologist likely recommend an ECG, an Echo, both, or neither?
Hopefully, by now you recognize the complementary aspect of ekg and echos.
Since echos are not very good at differentiating rhythm abnormalities, an ekg would be performed on the patient. Hopefully the ekg could be performed while the patient is having the heart palpitations.
Now once, we have detected the underlying rhythm abnormality, we then ask ourselves why is he/she having this problem. We then may perform an echocardiogram to look for structural heart disease.
Dear Malpractioner, I hope I have piqued your interest into the fascinating world of cardiology. I think the other posts were just a reflection of the broadness of your question.
It's like going to an Indianapolis Colts forum and asking, "What is the difference between offense and defense? Is a good offense a sign a healthy team?What can offense do that defense can't do? If the New England patriots scored 20 points, would the colts try to play better offense, better defense, both or neither?"
Thus, while the above post was made in a football forum, one could imagine that other members of the forum may have a field day with the post.
