Visiting The Cardiologist...


Several years ago Fran and I both needed to get a cardiac stent, me for some very minor chest pain and her for a very slight arrhythmia. 

Today we visited a cardiologist in Liberia just as a matter of routine to make sure all is well with out tickers.  Before you continue reading, I just want to let you know that the test results were normal and that we appear in pretty decent shape, at least according to the tests.

A few weeks ago we visited our CAJA (national medicine) doctor to begin the process for an annual check up.  Part of our plan was to visit a CAJA cardiologist so that we can have a stress test and echo cardiogram examination.  Our CAJA doctor told us that it might take as long as 12 months in order to have a CAJA cardiologist perform these tests.  Bullshit!  To mitigate the year long wait, we opted to go to a private cardiologist in Liberia. 

On the recommendation of a friend, we made an appointment for Saturday, September 3.  We arrived at 11am and were escorted into his office about 10 minutes later.  The office was somewhat spartan, but it did appear to have the necessary basic elements to perform an echo cardiogram and a stress test.


Fran went first.  After donning a modesty gown, the doctor proceeded to do a thorough echo test on her heart.  The equipment appeared fairly modern, generating some fairly easily discernable images.  I was able to clearly see Fran's mitral valve opening and closing as well as normal venus blood return through her main cardiac vein, the vena cava. 

After she was through, I jumped up on the table and had the same thing done to me.  It was quick and painless.  All appeared to be functioning as nature had intended.  My heart action looked good and made all the correct sounds a working heart should make.

After passing the echo test with flying colors, it was time to get wired up and jump on the treadmill for the stress test.  Again, Fran went first.  Fran needed to get her heart pumping at a rate of 153 beats per minute (BPM).  After 6 minutes she successfully hit her mark.

Now it was then my turn. I needed to hit the 160 BPM mark.  After 8 minutes of humping it uphill, I was only able to get my resting heart rate of 62 up to 120.  Hmmm, maybe I'm in better shape than I figured!

While on the treadmill, I began chatting with the doctor about various things.  Since I am an ex-paramedic, I am very familiar with emergency medicine, especially cardiac issues.

I noticed the obvious absence of a "crash cart" in his examination room.   Crash carts are used in the event of a medical emergency like a heart attack.  They carry life saving equipment such as cardiac monitors and  defibrillators,  cardiac drugs including epinephrine and lidocaine, IV solutions, nitroglycerine and various tubes for performing airway intubation.  These are basic tools needed to save a life during a cardiac arrest.  When I asked the doctor where the crash cart was, he seemed unfamiliar with that term.  After I explained to him what it was, he told me that his office was not equipped with that piece of equipment. 

When asked what would happen if someone had a heart attack while doing a stress test, he said, "I would call the paramedics."  Well in my opinion, given the slow response time of of Costa Rican ambulances, you might as well call a friggin' priest because you are going to need to administer LAST RIGHTS!

For me, that level of care is a huge red light indicator telling me that this guy is NOT going to be my long term cardiologist.

As for the test, it appeared thorough.  Was it sufficient to determine the likelihood of a cardiac incident? Not in my opinion.  A nuclear stress test is a much better determinant because it measures blood profusion from the heart.  This is a much better (initial) indicator than just looking at an EKG or an echo cardiogram. 

But the price I paid was great, considering what we received.  For both the Echo Cardiogram and the Stress Test EKG, our total cost was only $220 each.   This would have been thousands of dollars back in the States.  However, with the advent of the new CIMA hospital opening near me, there will inevitably be more qualified and better equipped doctors from which to choose.


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