Cardiology Consult/Work Up Question

[MexicanDr]

Hello everyone-

I currently work as an NP/PA for inpatient cardiology and we are in the process of getting trained/educated on Cardiology consults by out inpatient cardiologists.

Do you guys have a template/outline for the cardiology consults you guys do? What does your complete cardiac work up entail? I know this varies by the admission dx, but in general perspectives do you guys have anything like this that you could share?

Thanks!

---

Members don't see this ad.

 

[residentk3]

Glad you choose cardiology, it’s a great field although many times it is exhausting. I truly believe creating a template for a cardiac work up will hinder you more than help you. From the outside it may seem that every patient gets an ekg, echo, stress, cath, +/- cardiac CT/MR, however there are many nuances to when these should be ordered and when to rely on them. It is easy to shotgun approach and order everything for everyone, and much more difficult to interpret what comes back.

A test or study is only as good as the context in which it is obtained. Good luck and never let the ego get in the way of asking for help.

 

[nlax30]

I agree in that a template for a "complete cardiac work up" really doesn't do anyone justice and would not be helpful.

As was said above it's going to vary on what exactly you're wishing to work up.

What prior experience in cardiology do you have? If not a lot of prior cardiac exposure it's probably going to take some time to develop a framework for each general cardiac "issue" and how you are going to approach each one based on your particular group and what's available to you.

So in general I would start by categorizing what are the main topics you will regularly need to evaluate and work up (some of these may depend on your local group's practice patterns and what they typically treat:
-Chest pain
-Random Mildly elevated troponin (you will get this, in spades)
-ACS/MI
-CHF, systolic and diastolic
-Syncope
-Arrhythmias --> AF/flutter, SVTs, VT, Bradycardia
-Cardiac risk assessment for surgery (pre-op evaluations)
-Valvular disease: if adults then certainly focusing on AS and MR
-Endocarditis
-Peripheral vascular
-LE claudication
-Peripheral vascular emergencies/limb ischemia
-Device issues: Pacers, ICDs, CRTs
-Pericarditis/myocarditis
-Lipid disorders
-Congenital (big/broad topic and depends on local patterns so may not be a big component of your practice)

There's a general topic list off the top of my head and could be a place to start thinking about how you want to approach each one of those. Each is going to have it's own nuances in terms of questions to ask about in the H&P, inpatient vs outpt approach, physical exam priorities and diagnostic testing.... some of which could be a simple history/physical and reassurance with no further testing up to needing the million dollar workup with ECHO, stress, CT, cath, etc.....

Do you currently have any good cardiology source/texts that you have or are using? I'm not sure your background or comfort level in general with cardiology but if you just need a down to earth basic handbook then you could consider the Washington Manual Subspecialty Series Cardiology (Washington Manual of Cardiology Subspecialty Consult)