MBBS OSCE · Cardiology
OSCE — Aortic Regurgitation
Eight-minute OSCE station on Aortic Regurgitation: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Aortic Regurgitation.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Aortic regurgitation (AR) is diastolic incompetence of the aortic-valve complex permitting backflow from the aorta into the left ventricle. In chronic AR the LV remodels by eccentric hypertrophy, giving the classic signs — early-diastolic decrescendo murmur at Erb point, wide pulse pressure, water-hammer (Corrigan) pulse and a constellation of peripheral signs (de Musset, Quincke, Traube, Duroziez, Hill). Causes are leaflet disease (rheumatic, bicuspid, endocarditis) or aortic-root dilation (Marfan, hypertension, ankylosing spondylitis, syphilis). Acute severe AR (endocarditis, type A dissection, trauma) presents as sudden pulmonary oedema without the classic signs. Diagnosis is by echocardiography, which grades severity and tracks LV size and function; aortic valve surgery is indicated for symptoms, for a falling ejection fraction (55 percent or below for ACC/AHA, 50 percent or below for ESC/EACTS), or for an LV end-systolic diameter over 50 mm, and an intra-aortic balloon pump is contraindicated in anything more than trivial AR.[1][2]
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Sudden severe dyspnoea with a new early-diastolic murmur and pulmonary oedema - acute severe AR; emergency surgery, never IABP |
| Safety | Acute severe AR with type A aortic dissection - surgical emergency; tearing chest pain, pulse deficit, inter-arm BP differential |
| Safety | Symptomatic severe chronic AR (dyspnoea, angina, syncope) - AVR indicated |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.[1][2]
References2ShowHide
- [1]Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines J Am Coll Cardiol, 2021.PMID 33342587
- [2]Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease Eur Heart J, 2022.PMID 34453165