Usually, no routine ECG is needed. NICE makes exceptions for cardiac concerns or another condition treated with medicine that increases cardiac risk. Its ECG recommendations cover stimulants, atomoxetine and guanfacine.1
Hearing that a heart test may be needed can raise two different worries: whether something has been missed, and whether the test will delay treatment. This guide explains the UK guidance and helps you prepare for that conversation. It is written for adults; it does not decide whether a particular reader needs testing or which medicine is suitable.
Key points
- Ask which heart checks are part of your assessment and what each is for.
- Share symptoms, previous investigations, family history and your medicine list.
- If an ECG is requested, ask what question it is intended to answer and who will review it.
- Keep urgent symptoms separate from questions that can wait for a planned appointment.
What is an ECG, and what does it measure?
An electrocardiogram, usually shortened to ECG, records the heart's electrical activity, including its rate and rhythm. A resting test is generally quick and painless. Small adhesive electrodes are placed on the chest and limbs while you lie still.2
Blood pressure is a different measurement: it concerns the pressure as the heart contracts and relaxes, usually measured with an arm cuff. High blood pressure often causes no symptoms, so feeling well does not establish that the reading is normal.3
These checks answer different questions. When discussing a result, use its name: an ECG report, a blood-pressure reading or a pulse measurement. That helps the clinician understand which information you already have.
What should happen before medication starts?
A question to start with: “What do you need to check before deciding whether this medicine is appropriate for me?”
The medicine itself also matters. NHS information asks adults considering methylphenidate to discuss heart problems, high blood pressure and blood-vessel conditions with their doctor or pharmacist.4
Non-stimulant treatment still needs attention to heart health. For atomoxetine, the MHRA advises a cardiac history and examination, recording pulse and blood pressure, and specialist evaluation where concerns arise. It can raise pulse and blood pressure, so an individual benefit-and-risk discussion remains important.5
A practical preparation: bring a current medicine list, including non-prescription products and supplements, and any previous heart-test reports you can access. If you do not have the documents, write down where and approximately when the investigation happened. Ask whether the clinician needs further records rather than trying to interpret an old report yourself.
When is specialist heart advice needed?
NICE recommends cardiology advice before starting ADHD medication for these findings:1
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| Area | Findings to discuss |
|---|---|
| Previous heart health | Heart disease present from birth, or previous heart surgery. |
| Family history | A parent, sibling or child dying suddenly before 40, apparently from heart disease. |
| Exercise and fainting | More breathlessness than peers during exertion; fainting with exertion or triggered by fright/noise. |
| Heartbeat and chest symptoms | Fast, regular palpitations starting and stopping suddenly; chest pain thought to be cardiac. |
| Clinical findings | Signs of heart failure, a murmur, or high blood pressure (adult hypertension). |
An ECG alone does not replace this specialist opinion.1
You do not need to decide whether a symptom fits a medical category before mentioning it. Describe what happened and let the clinician assess it. If family details are uncertain, say so. “I do not know” is more useful than guessing an age, diagnosis or cause of death.
What happens if I am referred for an ECG?
Follow the instructions for the test you have been offered. The NHS suggests clothing that is easy to remove and avoiding lotions or oils on the skin beforehand. You can ask for a chaperone or someone to be present. Different ECG tests include resting recordings, portable monitoring and exercise tests; the choice depends on the clinical question.2
If touch, adhesive patches, undressing or an unfamiliar room may be difficult, tell the team beforehand. Ask what they can explain in advance and what support is available. These are suggestions for discussing your needs, rather than a promise about a particular service's arrangements.
Before leaving, ask who receives the report, who will explain it and how to obtain an update. The NHS notes that results can take different lengths of time and that further tests may sometimes be needed.2
Does a normal ECG rule out every problem?
A brief recording may not capture symptoms that come and go. George Eliot Hospital's NHS information explains that longer monitoring can be used when intermittent palpitations, dizziness or fainting episodes may be missed by a standard ECG. This is one reason to keep describing symptoms even if a previous recording was normal.6
Ask how the result fits with the reason for referral. Useful questions include: “Has this answered the concern?” and “Do I need any further assessment before we agree the medication plan?” Avoid treating the word “normal” on a report as permission to start or change a prescription yourself.
What checks continue during treatment?
NICE recommends checking pulse and blood pressure before and after dose changes and six-monthly. ECGs require a clinical reason.1
For atomoxetine, the MHRA also advises prompt specialist cardiac evaluation if symptoms suggesting heart disease develop. A previous satisfactory assessment does not remove the need to report a new concern.5
Our medicines monitoring and safety guide explains follow-up in more detail. Keep the agreed contact route somewhere easy to find, and ask how to raise concerns between appointments.
When should I seek urgent help?
Call 999 if you currently have palpitations that do not go away, or palpitations with chest pain, breathlessness, feeling faint or fainting. Do not drive yourself to A&E. If these symptoms have stopped, seek an urgent GP appointment. Do not wait for a routine ADHD review or booked ECG.7
If you otherwise feel well but palpitations recur, become more frequent or last more than a few minutes, arrange a GP assessment. Mention any heart condition or relevant family history.7
Questions people often ask
My clinician asked for an ECG. Does that mean something is wrong?
Ask what prompted the request and what the result will help decide. An ECG can be used to investigate symptoms or as part of checks around certain medicines; the request itself is not a diagnosis.2
I do not know my biological family's medical history. What should I do?
Tell the prescriber what is known and what is unavailable. You can explain adoption, estrangement or uncertainty without inventing a reassuring answer. Ask how that uncertainty will be handled in your assessment.
I had an ECG before. Should I arrange another myself?
Bring the earlier report or its date and ask whether it answers the current question. Let the clinician explain whether another test is needed, what type it should be and how to arrange it. This article cannot set an expiry date for an individual ECG.
Could palpitations simply be anxiety?
Anxiety, poor sleep, caffeine and medicines can cause palpitations, but heart-rhythm problems and other conditions can also cause them. Describe new or recurring symptoms rather than deciding the cause yourself, and use the urgent advice above when applicable.7
What should I ask before booking a private ECG?
Ask why the test is needed, who should arrange it, whether there is a charge, what report is required and who will interpret it. Clarify the plan with the requesting clinician before paying for a test independently. This guide does not promise a particular NHS or private referral route.
For the wider prescribing discussion, see ADHD medication: options, effects and evidence and what to expect during titration.
References
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NICE NG87: recommendations, particularly 1.7.4–1.7.5 and 1.8.9–1.8.10.
Cited sections: baseline assessment · cardiovascular.
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NHS: Who can and cannot take methylphenidate for adults.
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MHRA: Atomoxetine—blood pressure and heart rate.
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George Eliot Hospital NHS Trust: Eclipse Mini Heart Monitor.
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