Thrills & Challenges
of Creating a “State of the Art” Echocardiography Center in Lagos, Nigeria / cont.
////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////////// One of the “eureka” moments of my first few months back happened during the annual scientific meeting of the Association of General and Private Medical Practitioners of Nigeria, where I was assigned a workshop on “utility of echocardiography in modern medical practice.” I presented case studies on dyspnea in three patients with identical presenting complaints, identical physical examinations, but with very different clinical diagnoses. The diagnoses were constrictive pericarditis secondary to chest radiotherapy, dilated cardiomyopathy probably post-partum, and acute pulmonary embolism most likely due to frequent long-distance road travel, respectively. The dramatic way diagnosis in each case was clinched using various modalities of echocardiography including 2D echo, Doppler, Tissue Doppler and transesophageal
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echocardiography (TEE) selectively, was the learning point I had hoped to communicate to my audience of savvy medical practitioners. I expected questions about my approach, for example of opting for TEE to demonstrate the presence of proximal pulmonary artery thrombi rather than CT pulmonary angiography which was not accessible to me to inform a decision to use thrombolysis. However, the tenor of the discussions after my presentations made me realize that many in my audience did not think that these types of cases exist in Nigeria. There was deafening silence when I pointed out the dates of the studies and that they were patients I had treated in Nigeria within the three weeks prior to the meeting.