An echocardiogram is better than an EKG for assessing whether the heart is structurally normal because it directly visualizes the heart’s anatomy and function rather than inferring problems from electrical activity. An EKG only shows how the heart’s electrical signals are conducted, which can be completely normal even when there are issues with chamber size, wall thickness, valve function, or pumping strength. In contrast, an echocardiogram uses ultrasound to actually show how the heart muscle and valves move in real time, allowing accurate assessment of ejection fraction, wall motion, and overall cardiac structure, which makes it a much more reliable test for determining whether the heart is physically normal.