In this conversation, Liz Rohr interviews Jennifer Carlquist, a physician assistant with extensive experience in cardiology, who discusses the assessment and management of chest pain.
They covered:
- Assessing cardiac versus noncardiac chest pain
- Assessing risk for MI and when to send patients to the ED or not
- What EKG findings to watch out for, and how to learn more to build your ekg reading confidence (and what’s new!)
- What we can do for patients to assess and manage heart disease risk, including labs and tests to check in primary care (including the coronary calcium score, LPa, and homocysteine)
- How to communicate and collaborate effectively with ER providers
- Further resources to learn if you’re in cardiology or interested in making the switch from primary care
Takeaways
- Consider both cardiac and non-cardiac causes of chest pain, especially in female patients with atypical symptoms.
- Take a detailed history, including risk factors and family history, and be aware of red flags that may indicate a more serious condition.
- Recognize the limitations of certain diagnostic tests, such as EKGs and troponin levels, and consider a CTA with FFR for outpatient testing.
- Collaboration between primary care providers and the ER is crucial, and concise reporting of findings is key to effective communication.
- Differentiating between hyperkalemia T-waves and hyperacute T-waves can be challenging, but hyperkalemia T-waves are pointy and hyperacute T-waves are more blunted and broad-based.
- Inverted T-waves in leads other than AVR and V1, especially if they are symmetric, can indicate the need for urgent evaluation.
- Q-waves can form within an hour of an infarction, and a small Q-wave in lead III without other abnormalities may be a normal finding.
- When learning EKG interpretation, it is important to start with understanding what a normal EKG should look like and then focus on high-risk findings.
- Inflammation is a significant risk factor for heart disease, and non-traditional risk factors such as psoriasis and early menses should be considered.
- Lab tests such as the coronary calcium score, LPa, and homocysteine can provide valuable information in assessing heart disease risk.
- Magnesium supplementation can be beneficial for patients with palpitations and hypertension, but the specific type and dose should be tailored to the individual.
- Primary care providers play a crucial role in assessing heart disease risk and can collaborate with cardiologists to order appropriate tests and make informed decisions.
- The three-day EKG challenge and the Cardiology Fundamentals Mentorship program are valuable resources for learning and advancing in cardiology.
- The importance of fostering a supportive and collaborative environment in healthcare to provide the best care for patients.
For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/assessing-chest-pain
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