OSCE: Cardiology

Dr Tejal Parekh (Respiratory Medicine) Dr Sarah Kolb (Trauma & Orthopaedics)

Aims and Objectives

Build on 3rd year skills Adaptability

Confidence in diagnoses
Feel prepared Ace the OSCE

Content
Focused History Cardiac Examination for finals Key diagnoses Aortic Stenosis Mitral Regurgitation Previous cardiac surgery Atrial Fibrillation Practical Run-through

The History
Wash your hands Introduce yourself Check your patients ID

Presenting Complaint HPC/ Associated symptoms PMH Drugs and Allergies Family History Social History Systems Review Summarise

Presenting Complaint
Chest pain SOB Palpitations Syncope/pre-syncope/ funny do

Drug Hx and Allergies

ACEi Betablockers Diuretics Statins Aspirin

Warfarin

SHx FHx S/R

Family History MI Angina DVT/PE/CVA Social Smoking Alcohol Exercise Tolerance
Systems Review (JADE/TAB/MARCH)

Differentials
Chest Pain Angina/IHD MI GORD SOB Heart Failure Valvular disease P.E. Palpitations AF/SVT Thyroid Caffeine/Alcohol Syncope Valvular Arrhythmia Postural Hypotension

P.E.
MSK

COPD/Asthma

Metabolic

Neurological

Summarise
This is a ___year old ___ who has presented with ____

She has a PMH of ____

Based upon these features my first differential would be ______

Other differentials are_____

I would suggest further investigations such as_____

Cardiac Examination
General Inspection Peripheral examination JVP Chest
Inspection, palpation, auscultation

Summarise Investigations

General Inspection
Around the patient: GTN Oxygen Telemetry Cigarettes Drip
The patient: appears comfortable, sat upright Expose and position

Peripheral
Hands
Endocarditis Clubbing Tar stains Cap refill Anaemia

Pulse
Rate Rhythm Character
Radio-radio delay Collapsing pulse Slow rising

Peripheral
Eyes Xanthalasma Pale conjunctiva Face Malar flush Central cyanosis Hydration Dentition Neck Carotid volume JVP

JVP
Six characteristics: Positional (45 degrees) Double pulsation Non-palpable Occlude-able Variable with respiration Hepato-jugular reflux

Chest
Inspection Scars Visible heave

Chest
Palpation Apex Beat Heaves Thrills Vibrations palpated secondary to a murmur Turbulence blood flow

Auscultation
Site Timing

Character
Radiation

Maneuvers

Site
Four key areas
Aortic Pulmonary Tricuspid Mitral

Timing

Radiation

Character
Aortic Stenosis
http://www.easyauscultation.com/cases-listingdetails.aspx?caseID=123

Mitral Regurgitation
http://www.easyauscultation.com/cases-listingdetails.aspx?caseID=91

Aortic Regurgitation
http://www.easyauscultation.com/cases-listingdetails.aspx?caseID=94

Mitral Stenosis
http://www.easyauscultation.com/cases-listingdetails.aspx?caseID=125

Maneuvers
Mitral Stenosis
Roll over to left side Listen with bell

Aortic Regurgitation
Lean forward Expiration

End Pieces
Auscultate lung bases Sacral and Peripheral oedema Hepato-jugular reflux Thank the patient Cover them up!

Summarise
This is a 65 yr old lady with___

These findings are in consistent with___

I would suggest doing further investigations such as___

Investigations
Bedside Tests Laboratory Ix Imaging Special Tests

Routine Obs
ECG

Haematology
Biochemistry Microbiology

CXR

Cardiac MRI

Echocardiogram Myocardial perfusion scan Angiography

Common Stations
Cardiac examination Aortic Stenosis Mitral Regurgitation Atrial Fibrillation Heart Failure

Aortic Stenosis
Key findings
Slow rising pulse Narrow pulse pressure JVP- raised if element of heart failure LVH: heaving apex beat, precordial thrill Ejection systolic murmur, loudest aortic area Radiation to carotids

Mitral Regurgitation
Key Findings:
Atrial Fibrillation Blood pressure often unchanged JVP- if element of heart failure Laterally displaced apex beat Heaves Pansystolic murmur in mitral area Radiation to axilla Signs of Infective endocarditis

OSCE STATION
You are an FY1 in MAU, a 74 year old lady has presented with SOB and lightheadedness, please carry out a cardiovascular examination and present your findings

ECG
What do you think of this ECG?

Summary
Focused History Likely diagnoses Examination for finals Likely findings How to summarise

What to expect

Questions