At best an EKG can give the possibility of heart muscle damage. An echocardiogram (ultra sound) can evaluate heart's ventricle walls for any movement impairment by visual real time of the pumping heart. Additionally, an echo software calculates the ejection fraction (EF), and that calculation indicates the amount of blood pumped out with each heartbeat. Heart muscle damage will be an EF below normal 55-75%, and heart failure is below 29%.