Assessing Chest Pain: New Red Flags & Risk Factors - Interview with Jennifer Carlquist, PA

In this conversation, Liz Rohr interviews Jen 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 & 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 & 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 benefit patients with palpitations & 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.

Chapters:
00:00 Introduction and Background
06:15 Thinking About Chest Pain: Differential Diagnosis & Red Flags
13:47 Recognizing Atypical Symptoms in Female Patients
19:45 Sending Patients to the ER: Effective Communication
25:38 EKG Interpretation: Avoiding Fancy Language
31:54 New STEMI Equivalents & Urgent Catheterization
35:44 The Significance of Inverted T-Waves & Q-Waves
39:48 Starting with the Fundamentals in EKG Interpretation
45:13 The Role of Inflammation & Non-Traditional Risk Factors
49:25 Lab Tests for Assessing Heart Disease Risk
53:25 The Benefits of Magnesium Supplementation
56:11 Collaborating with Cardiologists in Primary Care
01:00:31 Resources for Learning & Advancing in Cardiology
01:03:37 Creating a Supportive & Collaborative Healthcare Environment
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If you liked this, also check out:
Cardiology in Primary Care with Midge Bowers, NP
https://www.realworldnp.com/blog/card...

Heart Failure Management in Primary Care
https://www.realworldnp.com/blog/hear...

Resistant Hypertension in Primary Care Part 1
https://www.realworldnp.com/blog/resi...
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Please note: This episode is intended only for medical providers and students learning to be medical providers. While anyone is welcome to view and listen, for legal and safety reasons, we are unable to diagnose, treat, or answer medical questions for individuals through this channel. We always refer individuals back to their primary care providers for medical care. If you’re a medical provider or student and have specific patient cases you have questions about, I cannot answer those here but would love to help you inside our mentorship program!
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