OSCE — Dilated Cardiomyopathy · MBBS OSCE

Brief (to candidate)

You will assess a patient with a presentation consistent with Dilated Cardiomyopathy.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.

Clinical context

Dilated cardiomyopathy (DCM) is a disease of the heart muscle defined by dilatation and systolic impairment of one or both ventricles (LV end-diastolic dimension more than 117% of the value predicted for age and body surface area; with ejection fraction under 45%, or fractional shortening under 25%) unexplained by abnormal loading (hypertension, valve disease) or coronary artery disease sufficient to cause the impairment. It is the commonest cardiomyopathy, with a prevalence of 1 in 250 to 1 in 500, and a leading cause of heart failure with reduced ejection fraction (HFrEF), sudden cardiac death (SCD) and heart transplantation in the young. Aetiology is genetic in 30 to 50% (truncating titin variants in roughly 25% of familial and 18% of sporadic cases), but also myocarditis, alcohol, anthracycline chemotherapy, the peripartum state, tachycardia, haemochromatosis, sarcoidosis, thyroid disease and Chagas disease.

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	New heart failure with dilated LV and EF under 45% in the absence of CAD, hypertension or valve disease - dilated cardiomyopathy; begin aetiology work-up and four-pillar GDMT
Safety	DCM with syncope, near-syncope, family history of SCD under 50, NSVT on monitoring, or EF under 35% at 3 months - high sudden-death risk; consider ICD
Safety	LV apical thrombus, atrial fibrillation, or prior embolic event - anticoagulate (DOAC or warfarin)
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.