Cases’ possibilities in the cardiology or cardiovascular system examination station are broad. However, this post enlists common CVS cases that one can expect to encounter during exams. Seemingly oversimplified list, yet it can give you a clear head as to what to stress upon.
1. Prosthetic Heart Valves
Common in UK centers. Can be either Mitral, Aortic, or both. You are not expected to pick the type of prosthetic valve but if you are able to pick, obviously you will have an advantage.
2. Mitral Stenosis
Mitral Stenosis (MS) is an exam favorite. Try to assess the severity of mitral stenosis clinically, & pick associated abnormalities.
3. Mitral Regurgitation
Mitral Regurgitation (MR) is easy to pick due to the higher grade usually, typical apical, pan-systolic murmur radiating to the left axilla.
4. Aortic Regurgitation
If you find Aortic Regurgitation (AR) with no other murmur, look for aetiologies associated with pure AR i.e. Marfan’s syndrome, Ankylosing spondylitis, Syphilis, etc.
5. Aortic Stenosis
Aortic Stenosis (AS) is encountered commonly in the elderly due to aortic valve degeneration/aortic sclerosis.
6. Mixed Valvular lesions
Almost always due to Chronic Rheumatic Heart disease.
Combos include concomitant MS & MR, concomitant AS & AR, or mixed aortic & mitral valve lesions.
7. Ventricular Septal Defect
Think of it in a pan-systolic murmur with left parasternal thrill.
8. Atrial Septal Defect (ASD)
Think of it if:
i) No physical signs were found. Chances are that you might have missed the fixed splitting of ASD.
ii) Ejection systolic murmur in the pulmonary area. (Ejection systolic murmur is also heard here in Pulmonary stenosis but isolated pulmonary stenosis is very rare. Pulmonary stenosis, if given in the exam, is a finding in the Tetralogy of Fallot, and other signs will also be there).
iii) Patient has only AF but the first heart sound is not loud.
“Complacency is the last hurdle standing between any team and its potential greatness.”
Pat Riley