The Women's Health Inquiry Project

Adult ECGs in acute and emergency assessment: what is supposed to happen, and why it matters for women

Patient-Focused Article: Understanding ECGs in Emergency Care – What Women Need to Know

If you experience sudden chest discomfort, breathlessness, collapse, or palpitations, an electrocardiogram (ECG) is often one of the first tests performed in emergency settings across the NHS. This quick, painless recording of your heart’s electrical activity helps clinicians assess whether symptoms could relate to a heart problem.

Many women describe their symptoms differently from the “classic” crushing central chest pain often portrayed in public awareness campaigns. You might notice jaw, back, or shoulder discomfort, unusual tiredness, nausea, or a vague sense that something is wrong. National reviews and patient accounts highlight that these can sometimes be initially attributed to anxiety, indigestion, or other non-cardiac causes, potentially leading to delays in ECG recording and further assessment.

What usually happens in an emergency

On arrival, staff take observations and ask about your symptoms. For suspected cardiac issues, guidance from NICE and others expects a 12-lead ECG promptly—often within minutes. Electrodes are placed on your chest, arms, and legs; the recording takes a few minutes. It is non-invasive with no radiation or needles.

The ECG is reviewed alongside your history, and repeat recordings or blood tests (such as troponin) may follow. In pre-hospital care, ambulance crews may perform an ECG and transmit it if a heart attack is suspected.

Why this matters particularly for women

Cardiovascular disease is a leading cause of maternal death in the UK, and inquiries like MBRRACE-UK show that cardiac symptoms in pregnancy or postpartum can be mistaken for normal changes. Women have historically been under-represented in heart research, contributing to differences in how symptoms are recognised. Delays in ECG and treatment for conditions like STEMI are documented, linked to longer times to reperfusion and potentially worse outcomes.

Practical information for patients and families

  • Ask questions if something feels unclear. “Could this be related to my heart?” is a reasonable query.
  • If symptoms persist or return after initial reassurance, seek re-assessment.
  • In pregnancy or the postnatal period, report severe chest pain, breathlessness at rest, or palpitations promptly.

This article forms part of the broader Women’s Health Inquiry Project exploration of how healthcare pathways can better reflect women’s biology and lived experience across the life course.

See related pages on maternity care safety and diagnostic listening. Links to follow if not yet present here, the website is still under construction.

Mandatory disclaimer

This article is for general information and discussion only. It is not medical or legal advice, nor a substitute for professional advice. To contribute evidence, ideas, or corrections, please email womenshealthproject@outlook.com. Please do not share personal data when emailing. Individual cases cannot be reviewed.

This project does not offer any form of legal service and cannot assist with complaints, claims or individual advocacy. This platform is independent and not affiliated with any law firm, regulator, inquiry or clinical body.

© 2026 Women’s Health Inquiry Project (WHIP). This article includes original analysis of material from publicly available national sources. It may not be reproduced without permission.

References

  1. National Institute for Health and Care Excellence. Chest pain of recent onset; acute coronary syndromes. Available at: https://www.nice.org.uk
  2. National Institute for Health and Care Excellence. Transient loss of consciousness. Available at: https://www.nice.org.uk
  3. Society for Cardiological Science and Technology. Standards for 12‑lead ECG recording and reporting. Available at: https://www.scst.org.uk
  4. Health Services Safety Investigations Body. Investigation into early recognition and treatment of STEMI. Available at: https://www.hssib.org.uk
  5. British Heart Foundation; British Cardiovascular Society. Reports on women’s cardiac symptoms and disparities. Available at: https://www.bhf.org.uk
  6. MBRRACE‑UK. Saving Lives, Improving Mothers’ Care. Available at: https://www.npeu.ox.ac.uk/mbrrace-uk
  7. Royal College of Obstetricians and Gynaecologists; NHS England Maternal Medicine Networks. Guidance on acute deterioration and cardiac red flags in pregnancy. Available at: https://www.rcog.org.uk
  8. Joint Royal Colleges Ambulance Liaison Committee. Ambulance clinical practice guidelines. Available at: https://aace.org.uk/jrcalc
  9. Getting It Right First Time (GIRFT). Cardiology specialty report. Available at: https://www.gettingitrightfirsttime.co.uk
  10. NHS. Electrocardiogram: patient information. Available at: https://www.nhs.uk
  11. Smolina K, et al. Sex differences in STEMI diagnosis and treatment. European Heart Journal. 2019. Available at: https://academic.oup.com

Additional sources

  • Royal College of Emergency Medicine. Emergency department clinical standards
  • NHS England. Urgent and emergency care improvement materials
  • PHSO. Reports on diagnostic overshadowing
  • NHS Resolution. Thematic reviews on diagnostic delay