When practicing cardiovascular system examination (or simply cardiology station) for the OSCEs, follow these simple, basic yet powerful tips.
So let’s begin!
1. Spare 5 to 10 seconds for general inspection
At times, you may get the diagnosis just by a careful inspection. It can be disastrous during an exam if you miss a very obvious diagnosis such as Marfan’s syndrome, missed only by not doing an inspection properly.
2. Look for a mid-sternotomy scar
Mid-sternotomy scars can be missed in dark-skinned patients and/or due to chest hair.
If you find a sternotomy scar, you are likely dealing with prosthetic heart valve patients, coronary bypass-graft patients, or patients with previous corrective surgery of ventricular septal defects, atrial septal defects, or open valvotomy.
A further practical tip in such patients is to look for graft site scars on the ankle to commit a diagnosis of CABG surgery if a scar is present there as well.
3. Feel the pulse properly
If you find an irregularly irregular pulse in the CVS station, there are only a few common possibilities which are mitral stenosis (MS), Atrial septal defect (ASD), and severe mitral regurgitation (MR).
If you find the pulse is collapsing, you are dealing either with aortic regurgitation (AR) or Patent Ductus Arteriosus (PDA).
4. Palpate the apex beat properly!
The location and character of the apex beat can tell you the diagnosis.
You may probably diagnose mitral stenosis (tapping apex), mitral regurgitation (displaced, heaving), aortic stenosis (thrill in the aortic area with radiation to the neck) & Aortic regurgitation (hyperdynamic, displaced, heaving) depending merely upon the apex beat, even before you auscultate the precordium.
Furthermore, NEVER MISS a Dextrocardia!
5. Never diagnose VSD if ...
Never diagnose a VSD if you cannot feel the thrill over the left parasternal area.
6. Always look for four Cs in the cardiology station
Look for these 4 Cs namely Cause, Course, Complication, and Consequences of the illness.
For example, if you find that the patient is having mitral stenosis, look for a cause – underlying etiology is most probably chronic rheumatic disease, course (the stage of disease progression either mild, moderate, or severe), complication (whether this patient has developed atrial fibrillation, pulmonary hypertension) and consequences of the complication (whether this patient has embolic stroke due to atrial fibrillation or he/she is on long-term anticoagulants).
7. If you can hear a very loud pan-systolic murmur over the left sternal edge ...
If you can hear a very loud pan-systolic murmur over the left sternal edge, along with central cyanosis and/or peripheral clubbing, you are most probably dealing either with ASD/VSD with Eisenmenger’s syndrome or tetralogy of Fallot (TOF).
To differentiate between these two diagnoses, listen carefully for the second heart sound.
In ASD/VSD with Eisenmenger’s, patients must have developed pulmonary hypertension, you will hear a very loud second heart sound.
In TOF (where the pan-systolic murmur is due to VSD), the second heart sound is soft because of pulmonary stenosis.
8. Always say this at end of examination...
When you finish examining your patient, always tell the examiner that you would complete the examination by checking this patient’s BP (especially in patients with aortic stenosis and regurgitation), temperature ( especially in patients whom you suspect have infective endocarditis), and performing fundoscopy (in suspected infective endocarditis patient).
9. Look for multiple/mixed valvular lesions
In a patient with chronic rheumatic disease, always look for multiple valvular pathologies because these patients may have mixed mitral (MR with MS), mixed aortic valve disease (AR with AS), or mixed mitral and aortic lesions.
10. Practice skills to improve
Practice a lot! This is the only way that will make you proficient at picking signs!
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