MBBS OSCE · Cardiology

OSCE — Cardiogenic Shock

Eight-minute OSCE station on Cardiogenic Shock: focused history, examination priorities, investigations, emergency and definitive management.

8 min stationVerification in progress
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NEET-PGINICETUSMLEPLAB

Brief (to candidate)

You will assess a patient with a presentation consistent with Cardiogenic Shock.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.[7]

Clinical context

Cardiogenic shock (CS) is a state of end-organ hypoperfusion due to cardiac pump failure, defined for acute MI by SHOCK-trial criteria: systolic blood pressure below 90 mmHg for at least 30 minutes (or vasopressors to maintain SBP at least 90), cardiac index at or below 2.2 L/min/m2, PCWP over 15 mmHg, and signs of hypoperfusion (cool peripheries, oliguria under 30 mL/hour). The commonest cause is acute MI — typically large anterior STEMI, but also right ventricular infarction and mechanical complications (papillary muscle rupture, ventricular septal rupture).[7][1]

Candidate tasks

  1. Clarify onset, severity, associated features, and red-flag symptoms.
  2. State focused examination priorities.
  3. List first-line investigations and any named score/criteria.
  4. Give immediate resuscitation steps.
  5. Outline definitive management with doses/routes where standard.
  6. Name complications and disposition (ward / HDU / theatre / discharge safety-net).
  7. Mention one special-population modifier (pregnancy, child, elderly, CKD).[2]

Examiner checklist

DomainPass behaviours
DefinitionCorrect working diagnosis language
AssessmentFocused, prioritised, red flags sought
InvestigationsAppropriate first-line + interpretation
Emergency careABC / time-critical actions first
Definitive careSpecific drugs/procedures, not generic phrases
SafetyAcute MI with hypotension (SBP below 90), oliguria, cold peripheries, confusion, raised lactate — escalate
SafetyNew pansystolic murmur after MI with sudden haemodynamic collapse — papillary rupture or VSR; emergency echo
SafetyRV infarct (inferior MI, raised JVP, clear lung fields, hypotension) — preload-dependent; avoid nitrates
CommunicationClear 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.[7][1]

References9Show
  1. [1]Hochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators N Engl J Med, 1999.PMID 10460813
  2. [2]Hochman JS, Sleeper LA, White HD, et al. One-year survival following early revascularization for cardiogenic shock JAMA, 2001.PMID 11176812
  3. [3]Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock N Engl J Med, 2012.PMID 22920912
  4. [4]Thiele H, Akin I, Sandri M, et al. PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock N Engl J Med, 2017.PMID 29083953
  5. [5]De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock N Engl J Med, 2010.PMID 20200382
  6. [6]Mathew R, Di Santo P, Jung RG, et al. Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock N Engl J Med, 2021.PMID 34347952
  7. [7]Samsky MD, Morrow DA, Proudfoot AG, et al. Cardiogenic Shock After Acute Myocardial Infarction: A Review JAMA, 2021.PMID 34751704
  8. [8]Jentzer JC, van Diepen S, Barsness GW, et al. Cardiogenic Shock Classification to Predict Mortality in the Cardiac Intensive Care Unit J Am Coll Cardiol, 2019.PMID 31548097
  9. [9]Forrester JS, Diamond GA, Swan HJ Correlative classification of clinical and hemodynamic function after acute myocardial infarction Am J Cardiol, 1977.PMID 835473
OSCE — Cardiogenic Shock · MBBS OSCE · NeetVellum