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

cardiology clinical topics interviews podcast Aug 22, 2024

I’m SO envious of Jennifer Carlquist’s knowledge. She’s a cardiology Physician Associate who has worked in outpatient, ED, and inpatient cardiology for 17 years, and before that, worked for 13 years as a paramedic 😮.

When I was a newer NP, I remember wishing I could plug my brain into my supervisor’s brain and download all the clinical knowledge they knew. Honestly, I still feel that way. I wish I could download every little bit of cardiology knowledge from her!

In primary care, we have to hold so many pieces when it comes to the specialties, we simply cannot keep up with all the new developments that happen with each one.

Since she’s in cardiology, she gets to delve into not just guidelines, but new papers on developing evidence and is really on the cutting edge of practice.

This interview is absolute gold. There are so many things to talk about in cardiology— we decided to focus on assessing chest pain and what new developments are happening.

We 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
Further resources to learn if you’re in cardiology or interested in making the switch from primary care

I would ADORE to have her back on the podcast, so stay tuned and hopefully we can all learn more from Jen!

Here are some key takeaways from this episode:

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.