MBBS OSCE · Cardiology
OSCE — Long QT and Channelopathies
Eight-minute OSCE station on Long QT and Channelopathies: 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 Long QT and Channelopathies.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Long QT syndrome and the related cardiac channelopathies (Brugada, CPVT, short QT, early repolarisation) are inherited arrhythmia syndromes caused by mutations in cardiac ion-channel genes that predispose young, structurally normal hearts to syncope, torsades de pointes, ventricular fibrillation and sudden cardiac death. The dominant therapy is beta-blockade (nadolol or propranolol for LQTS and CPVT), avoidance of QT-prolonging drugs, lifestyle modification, and ICD implantation for secondary prevention or high-risk primary prevention.[1] Acute torsades de pointes is treated with a slow 2 g IV magnesium push, defibrillation if pulseless or sustained, and rate acceleration by overdrive pacing at 90 to 110 beats/min for pause-dependent forms — isoprenaline (10 to 20 microgram IV push, or an infusion titrated to about 100 beats/min) is reserved for acquired long QT, because in congenital LQTS it is contraindicated and can paradoxically lengthen the QT.[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 | Seeks syncope during exercise, swimming, auditory stimulation or emotional stress in a young patient - thinks LQT1, LQT2 or CPVT, restricts exercise, starts a beta-blocker, refers urgently to cardiology |
| Safety | Recognises torsades de pointes on a QT-prolonging drug (macrolide, fluoroquinolone, antipsychotic, methadone, amiodarone, sotalol, ondansetron, haloperidol) - stops the drug, gives intravenous magnesium sulfate, replaces potassium and magnesium to target, defibrillates if pulseless or sustained |
| Safety | Recognises a Brugada type 1 pattern (coved ST elevation of 2 mm or more in V1-V2) with syncope or VF - ICD is the only proven therapy, avoids sodium-channel blockers, treats fever aggressively |
| 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.
References2ShowHide
- [1]Priori SG, Wilde AA, Horie M, et al. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013 Heart Rhythm, 2013.PMID 24011539
- [2]Cohagan B, Brandis D Torsade de Pointes StatPearls, 2026.PMID 29083738