Ultimate guide to seeing a cardiologist in Singapore

I have been practicing as a consultant cardiologist since 2013 and I moved from Glasgow in the United Kingdom to Singapore in 2015. It always surprises me that people have very little idea as to what a cardiologist does and when they would need to see one! In this article I talk through some of the commonest questions I get from friends and patients. In addition I take a look at the costs involved in seeing a cardiologist. This is more important for people that perhaps don’t have insurance, as most insurance plans will cover cardiology outpatient and inpatient treatment.

What does a cardiologist do?

A cardiologist is a doctor who specializes in diseases of the heart and blood vessels. They are highly specialized and have usually spent a minimum of 10 years of training AFTER they finish medical school! The average age of a cardiologist at the beginning of their career will be just over 34 years old. During their training they will have been trained in all types of heart and artery disease, but the topic is so in depth that they will also chose a subspecialty interest, this is an area that they become in-depth experts on. I will go into that into a bit more detail on this later.

When do i need to see a cardiologist?

This is a very common question so I have broken it down into common symptoms that would need a cardiologist review and common conditions that get managed by a cardiologist.

If you develop the following symptoms, then a cardiologist is the best doctor to visit.

  • Chest pain
  • Breathlessness
  • Palpitations – feeling of fast or irregular heart beats
  • Giddiness or syncope (blackouts)

If you get diagnosed with one of the following conditions then a cardiologist will help look after you

  • Coronary artery disease – “furring up of the arteries” or “blockages”
  • Hypertension (high blood pressure)
  • Hyperlipidemia (high cholesterol)
  • Heart failure / cardiomyopathies – often caused by a weak heart muscle
  • Vasovagal syncope – “fainting spells” or blackouts
  • Atrial fibrillation or other arrhythmias – irregular/fast heart rhythms
  • Valvular heart disease – damaged valves in the heart

If you have other conditions that increase the risk for the development of heart disease then a cardiologist is a good person to see, because they can help find out if you have developed heart problems from it.

  • Diabetes
  • High blood pressure
  • Smoking
  • Family history of heart disease
  • High cholesterol

How is a cardiac surgeon different from a cardiologist?

Cardiologists treat all conditions of the heart and blood vessels. They will most often use medication to treat it, but they are also able to do minimally invasive procedures to open up blockages, treat heart arrhythmias and put in pace-makers. These procedures are called angioplasty and ablation. If your cardiologist is unable to treat your condition fully with medication or minimally invasive procedures, and the disease is amenable to surgery then your cardiologist may refer you to a surgeon. Heart surgeons are called cardiothoracic surgeons they specialize in doing operations that require opening of the chest cavity. These are often quite major operations that require the chest to be opened fully and a heart lung bypass machine to take over the work of the heart and the lungs whilst the heart or vessels are operated on.

What is the difference between treatment in the private and public healthcare system in Singapore?

There are 2 systems of care in Singapore, private and public:

  • Public – If you are a Singaporean or a permanent resident you can see a cardiologist at one of the public hospitals
    for a subsidized rate. Yes, the price will be lower, BUT, waiting times are longer than in private and you often only get to spend 10
    minutes with your specialist. If you want to see a public specialist you usually need to be referred there by a GP from a polyclinic,
    or another public specialist.
  • Private –Anybody can see a private cardiologist. They practice in all the major private hospitals such as Mount Elizabeth
    Orchard, Mount Elizabeth Novena and Gleneagles. You can often see a private cardiologist and have
    the necessary tests done on the same day, and walk out with diagnosis and
    treatment! Private cardiologists do cost more than subsidized care however. You can also see a “public” cardiologist privately but again their
    waiting times are longer.

How do I select a cardiologist?

  1. Do you have insurance? If you have medical insurance that covers out-patient cover, then the first step is to contact your insurance company. They will have a “panel” of cardiologists you can choose from
  2. Does the cardiologist’s subspecialty interest matter? To be honest, it doesn’t matter. Every cardiologist can investigate and manage pretty much every heart condition. If they require help with specialist procedures then they will bring in another cardiologist to help in your case when necessary.
  3. Personal recommendation? Recommendations can be useful particularly regarding the cardiologist’s bedside manner, however, word of caution, personal recommendations are rarely accurate when it comes to the skill of the cardiologist. It is very difficult for a patient to judge on the skills of their doctor. Recommendations from other doctors often carry a little more weight than recommendations from friends particularly regarding a doctor’s skills.
  4. How quickly can they see you? If you call a specialist and an appointment takes 2-3 weeks then you should consider going elsewhere. There are plenty specialists that can see you within 1 or 2 days and they will fit things around your schedule.

What happens at a first visit to a cardiologist?

The first cardiology visit can be broken down into key steps:

  1. Registration –When you get into the cardiologist’s office you will be asked for your details and if you have any referral letters from a GP or another specialist. You will also be asked for details of insurance if you have any. They may or may not perform an ECG and take your blood pressure prior to seeing your doctor.
  2. Consultation –Your cardiologist will call you into their room and sit to talk with you to begin. They will “take a history” this is a structured conversation about key areas of your symptoms, past medical history, drug history, family history, smoking and alcohol intake. Following this the cardiologist will perform a clinical examination focusing on the heart and vascular system. If you are female they will have a chaperone in the room. Following the history and examination there is usually a discussion about the potential diagnoses and the cardiologist will select a number of tests that need done to investigate things further.
  3. Testing – You may then undergo a series of tests that my include:
    1. ECGs – Electrical heart tracing
    2. Treadmill stress test – Running ECG stress test
    3. Echocardiogram – Ultrasound to look at heart function
    4. Holter monitoring – Portable 24 hour ECG
    5. Stress echocardiogram – Stress ECG also using ultrasound
    6. Artery ultrasound – To look at arterial health
    7. CT or MRI scans – Detailed scans of the heart muscle and arteries
    8. Nuclear stress tests – Stress test using nuclear tracers

Some of these tests will be done in you cardiologist’s practice and some will need to be performed at external providers.

  1. Follow-up appointment – In some cases testing and follow-up appointment will be done on the same day. In other cases it will take some time to do all the tests and get the results, so your follow-up appointment will be on a different day. In the follow-up appointment your cardiologist will discuss the test results and the likely diagnosis. They will then recommend treatments.
  2. Treatment – This will usually involve some type of medication. The medications used in heart conditions are often incredibly well investigated with lots of clinical trial evidence to back them up. Usually, your cardiologist will treat you in a similar way as recommended by national guideline recommendations. Sometimes in addition to medication a minimally invasive treatment may need to be performed. (see below)

What tests do cardiologists do and what do they cost?

Cardiologists tend to order the same tests, and often they will be performed by the staff in the clinic who will be trained in it. The cardiologist will generally finalize the report. There is some variation in price between the in-clinic tests in Singapore, but not a lot. Shopping around will save you <$100SGD usually for the standard tests. If a cardiologist’s price is high, sometimes it can be because they are a particular expert in that type of test and not many clinics can perform it. For example, stress echocardiography and arterial ultrasound are technically challenging and require a high degree of skill and training to offer to patients. The following prices are ballpark ranges in private cardiology out-patient clinics in Singapore dollars (SGD):

  • First consult –$180 – $300 – Price will depend on the length of your consult.
  • ECG – An ECG is a simple test to look at the electrical signal of the heart. It is easy and gives the cardiologist a first glance at the health of the heart. Usually it will cost in the region of $60 – $80
  • Echocardiogram – An echocardiogram is a heart ultrasound test. It forms the backbone of heart assessment. The exam takes about 30 minutes, and there is no preparation needed on your part. You lie on a couch and a skilled cardiac technologist will take images of your heart to look at heart and valve structure and function. It will then be reported by your cardiologist. It will cost in the region of $450 – $600
  • Treadmill test –In a stress ECG treadmill test, you have ECG leads fixed to your chest with stickers, you then walk on a treadmill. Every few minutes it gets faster and the slope increases to put increasing levels of stress on your body and heart. The price ranges from $350 – $500.

What invasive treatments do cardiologists do and what do they charge?

The figures below are purely the fees for the cardiologist. The Ministry of Health sets a benchmark for fees, so usually the cardiologist fees will fall somewhere in this range. There are other costs on top of this including hospital fees and equipment etc. These push the price up significantly.

  • Coronary angiogram – A coronary angiogram is an invasive procedure where your cardiologist inserts a thin tube into your wrist or your groin, from there it gets positioned in the heart (coronary) arteries. A radio-opaque dye is injected and X-ray pictures are taken that allow us to see if there are any blockages in the heart arteries. Time taken about 30 minutes. Fees from$2150 to $3200
  • Coronary angioplasty – The procedure to open blockages. After a coronary angiogram, if there is a blockage that needs stenting, a wire will be passed down the artery, then a balloon over the wire. The balloon is blown up to open the artery, then a little metal stent is put in place to hold the artery open. Fees from$6700 to $12200 (Total bill size will often be $40000 to $60000)
  • Cardiac ablation –If you have a heart arrhythmia for example atrial fibrillation or an SVT, then you may be offered a cardiac ablation. In this procedure tubes are inserted into a vein at the groin and passed up to the heart. From there your cardiologist can make small “burns” in the heart muscle that can stop the arrhythmia from happening. These procedures can range from simple and short to more complex and 4 hours long, hence the wide price range. Fees from $4000 – $12000

I hope this article has been a useful summary of what we do as cardiologists and when you should consider seeing one. Here are some educational videos created by myself. If you have any questions at all I am more than happy to help. Just drop me an email at michael.macdonald@harleystreet.sg.

Related article: Ultimate Guide to Coronary Angiography and Angioplasty

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