Wow, have the cost of an FAA medical sky rocketted, or did I just go to the wrong place. Does your company fully refund the cost of your medical or just give a partial refund?

I always get a first class medical as it's my only visit to a doctor each year. Luckily I don't have any health problems and the EKG lets me know that I'm doing OK. I have heard the argument for only getting a second class medical, as you are less likely to fail that and get grounded by the Feds. However I would rather find out if I have issues sooner than later, and passing the first class gives me peace of mind.

If you want to find out earlier rather than later for any cardiac problems then just getting an EKG during a 1st Class medical will not provide that. Failing the EKG only indicates that the problem started long ago and now you are dealing with the results of that problem. You need to see a cardiologist and get a nuclear stress test and other imaging such as a PET scan or MRI. Only then will you know if you have any forth coming issues that need to be addressed now rather than later. I know many pilots who did this and found out that they were dealing with serious issues before having a heart attack or other disqualifying complications. If you dont care then get a 2nd class because it is cheaper but the resulting information is the same.

An electrocardiogram (ECG or EKG) is a highly effective, noninvasive test that detects various heart problems by recording the heart's electrical activity. It can identify arrhythmias (irregular heartbeats), structural abnormalities, and evidence of current or past heart attacks, often acting as a primary tool for diagnosing cardiovascular issues.

If something shows up on a EKG then its too late. (ie.. blockages or other related disqualifying issues). If you are trying to avoid this and be "proactive" then you have two choices; 1. Imaging 2. catheterization. 

You could have 80% - 90% blockage and the EKG may never show it, especially if you have collaterals! Imaging or getting a catheterization will always show you whats going on inside the vessel. Imaging = proactive / EKG = reactive - your choice.

I always go to the FAA website and call around… usually I can find one that does a class 2 med for around $160. 

I’ve done some good trolling over the years but this is good. A guy claiming he pays extra at flight physical time for a first class to be sure his heart is ok? 

Well played you landed a few.