MBBS OSCE · Cardiology
OSCE — Hypertrophic Cardiomyopathy
Eight-minute OSCE station on Hypertrophic Cardiomyopathy: 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 Hypertrophic Cardiomyopathy.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Hypertrophic cardiomyopathy (HCM) is an autosomal dominant sarcomere-protein mutation disease producing unexplained left ventricular hypertrophy, classically asymmetric septal. Histology shows myocyte disarray, interstitial fibrosis and intramural small-vessel disease. Dynamic left ventricular outflow tract (LVOT) obstruction with systolic anterior motion (SAM) of the mitral valve and secondary mitral regurgitation occurs in about two-thirds. The cardinal clinical threats are sudden cardiac death (SCD) in the young, diastolic heart failure, atrial fibrillation and angina from microvascular ischaemia. The bedside signature is an ejection systolic murmur at the left sternal edge that increases
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 | Young athlete with syncope on exertion, family history of SCD, or exertional che |
| Safety | Syncope, pre-syncope, or seizures on exertion in any HCM patient — high SCD risk |
| Safety | Documented non-sustained VT on Holter, unexplained syncope, massive LVH (over 30 |
| 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.